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Can Orthopaedic Surgery Go Green? Environmental Footprint of Disposable Versus Reusable Instruments in TKA
Shirin Monadjemi1, Guillaume Villatte2, Roger Erivan2
1Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Clinical Orthopaedics and Related Research
|February 27, 2026
Summary
Choosing between single-use and reusable surgical instruments involves environmental trade-offs. Reusable instruments procured on loan (RI-L) should be avoided due to their high environmental impact, while other options require careful consideration of all impact categories.
Area of Science:
- Environmental science
- Materials science
- Healthcare sustainability
Background:
- Growing attention on the environmental impact of surgical procedures and instruments.
- Increasing adoption of single-use instruments in healthcare, including orthopaedics, due to convenience.
- Ecological concerns arise from replacing reusable instruments with single-use alternatives, including waste, emissions, and resource depletion.
Purpose of the Study:
- Assess the environmental impact of single-use instruments and reusable instruments (stock and loan) in total knee arthroplasty (TKA).
- Utilize life cycle assessment (LCA) to determine the most ecologically sustainable option among single-use and reusable instruments.
Main Methods:
- Conducted a comprehensive life cycle assessment (LCA) following ISO 14040/44 guidelines.
- Evaluated environmental impacts including raw material extraction, manufacturing, distribution, reprocessing, and waste management.
- Assessed reusable instruments under two scenarios: kept in stock (RI-S) and procured on loan (RI-L), using GaBi 6 TS software and Ecoinvent 3.5 database.
Main Results:
- Reusable instruments kept in stock (RI-S) had the lowest carbon footprint (44.3 kg CO2 eq/procedure), while loan instruments (RI-L) had the highest (66.5 kg CO2 eq/procedure).
- Single-use instruments showed the lowest water depletion (6.3·10-1 m3 eq/procedure), whereas RI-S and RI-L contributed significantly more.
- Single-use instruments' impact stemmed mainly from raw material production, while reusable instruments' impact was heavily influenced by the sterilization phase.
Conclusions:
- Reusable instruments procured on loan (RI-L) should be avoided due to unfavorable environmental outcomes.
- Both single-use instruments and RI-S present environmental trade-offs, necessitating a holistic impact assessment.
- Strategies like optimizing reusable instrument trays and minimizing disposable consumables are crucial for greener surgical practices.
