WaSTE: a multicentre audit of waste segregation practices in elective knee and hip arthroplasty

Listen to Simon and Amy discuss the paper 'WaSTE: a multicentre audit of waste segregation practices in elective knee and hip arthroplasty' published in the April 2026 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today, we're delving into the paper 'WaSTE: a multicentre audit of waste segregation practices in elective knee and hip arthroplasty', published in April 2026 by R Prakash and colleagues. I am Simon and alongside me is my co-host Amy.

Hello everyone. This study highlights an important issue in orthopaedic surgery, waste management, particularly in elective knee and hip arthroplasty procedures. It's quite revealing how much waste is produced and where improvements might be made. The research quantified waste generated from primary total knee arthroplasty and total hip arthroplasty across several NHS trusts in the UK.

The authors aim to identify strategies for waste reduction and better segregation. Over a six-month prospective study period from October 2023 to April 2024 across 10 UK centres, they collected data from at least 10 arthroplasty cases per [00:01:00] centre. The waste was categorized and weighed into six streams: infectious, offensive, recycling, general, sharps, and linen.

They also gathered additional variables such as the number of scrubbed personnel, the type of drapes, implant brands used, and any intraoperative complications. Data from 222 procedures, including 92 total hip arthroplasties and 130 total knee arthroplasties, showed a significant variation in total waste production among the centres.

For example, total hip arthroplasties produced a mean of 14.8 kilograms of waste, while total knee arthroplasties generated slightly less at 13.6 kilograms. A notable observation was that only five out of the ten trusts used the offensive waste stream, which significantly reduces the carbon footprint compared to the infectious waste stream.

One of their key findings was that local waste management practices are the strongest predictors of waste production. This highlights the need for standardized practices and education [00:02:00] to ensure compliance with national guidelines. And it isn't just about the volume of waste. Infectious waste produces ten times more carbon dioxide than recycled waste, and over 90% of infectious waste is misallocated. That's a tremendous environmental impact.

Precisely, Simon. The study suggested that using the offensive waste stream could significantly reduce carbon intensity. For instance, some pilot data indicated that simple educational interventions could reduce infectious waste by several kilograms for both total knee and total hip arthroplasty cases.

Let's discuss some of the predictors of waste production they identified. They found that the number of scrubbed personnel, the type of implants, and whether reusable drapes were used, all impacted the amount of waste generated. However, after multivariable regression analysis, local centre practices were the only significant predictor.

Yes, and they also considered the role of implant packaging and industry collaboration. Reducing excessive packaging and [00:03:00] moving towards biodegradable or recyclable materials could help minimize waste from these surgeries. Another interesting point was the use of reusable drapes. Multiple studies have demonstrated the potential benefits of reusable drapes in reducing CO2 emissions, so the effect of reusable drapes on total waste should not be considered a reason to favor single-use drapes per se.

Switching from infectious to offensive waste streams can also be cost-effective. They estimate that this switch could save approximately £1.38 per total hip arthroplasty case and £1.22 per total knee arthroplasty case based on figures from the Royal Orthopedic Hospital NHS Foundation Trust.

In summary, the paper makes a compelling case for standardizing waste management practices across NHS trusts in the UK. By adhering to national guidelines, utilizing offensive waste streams, reducing implant packaging, and optimizing surgical team size, there's significant potential to reduce both environmental and financial costs associated with arthroplasty [00:04:00] procedures. Absolutely, Simon. It's evident that with the right interventions and collaboration between healthcare providers and the industry, we can significantly impact the carbon footprint of these common surgical procedures.

Well, that's all we have time for today. Thanks for joining us on this episode of AI Talks with Bone & Joint. See you next time.