Pulse lavage in lower limb arthroplasty: awash with carbon saving opportunities

Abstract

Introduction

Pulse lavage is used in cemented orthopaedic procedures to prepare the bone bed, improve fixation strength at the bone-cement interface, and reduce the risk of bone cement implantation syndrome. We sought to calculate the approximate carbon cost of battery-operated pulse lavage in Scotland for the year 2022. 

Methods

We used data from the Scottish Arthroplasty Project and Scottish Hip Fracture Audit to establish the number of primary hip replacements, knee replacements, and  hip hemiarthroplasty procedures performed in 2022. We modelled the standard uses of eight AA batteries (at 23g each) per case. To calculate the carbon footprint associated we used the ‘UK Government GHG conversion factors dataset’ to calculate the carbon footprint in material use (materials, manufacture, and transport) and disposal.

Results

Data from the Scottish Arthroplasty Project and Scottish Hip Fracture Audit established that 11,175 primary hip or knee replacements and 4,036 hip hemiarthroplasty procedures were performed in 2022. Therefore, around 15,000 pulse lavage units were used in primary lower limb arthroplasty. If each case had utilised a system which uses eight AA batteries (at 23g each) then 120,000 batteries equating to 2.76 tonnes, would have been used. The carbon footprint for material use (2.76 x 4633.48 = 12788.40) and for disposal (2.76 x 8.883 = 24.52) demonstrates a total carbon footprint of 12,813KgCO2 associated with the use of disposable batteries in pulse lavage for the year 2022.

Conclusions

Single-use, disposable battery use in orthopaedic joint surgery creates at a high but preventable carbon burden. Reuseable alternatives which utilise the power tool to drive the motor for pulse lavage may save up to 55% of clinical waste.