Bone Cement Waste in Total Knee Arthroplasty: A Preliminary Study of Scope and Cost

Medical waste is both costly and detrimental to the environment, and operating room waste represents a substantial portion of this. To the authors' knowledge, bone cement waste in total knee arthroplasty (TKA) has not previously been studied. The vast majority of TKA are cemented, and the volume of TKA is forecast to increase. Given this, we studied the waste resulting from the routine use of 2 40-gram bags of polymethyl methacrylate (PMMA) powder during cementing in primary TKA.

We first studied the yield of commercially available plain and gentamicin medium-viscosity bone cement powder and calculated the cost/gram of product. We then collected the PMMA remaining after primary TKA to determine the average amount of waste, its cost, and possible correlations with patient and implant metrics that could improve efficiency and reduce waste of PMMA.

Overall, PMMA waste averaged 59% per TKA, at a median cost of $129 per case. Cost of waste was greater when gentamicin cement was used, as its cost was 2.5X that of plain cement. Implant sizes and surface area ranges were identified that could reliably allow the use of a single 40-gram package of powder, potentially reducing PMMA waste.

While it is acknowledged that zero-waste cementing is not practical, any reduction in waste that does not compromise either the flow of surgery or the adequacy of fixation would be beneficial. Reevaluation of PMMA techniques could reduce waste, resulting in both cost savings and improved sustainability in arthroplasty.