Environmental sustainability and physical resource use associated with robot-assisted hip and knee arthroplasty: a...

Robot-assisted arthroplasty changes instrumentation, consumables and implant use, but its net environmental effect is uncertain. This scoping review mapped environmental and physical-resource outcomes in robotic hip and knee arthroplasty and assessed whether reported environmental quantities were comparable. A protocol was registered after editorial assessment of an earlier version and before revised searches of PubMed/MEDLINE, Ovid Embase and Scopus on 17 August 2026. Two reviewers independently screened records and full texts; 12 records initially excluded at title/abstract were independently reassessed during a consistency audit. Findings were classified as direct environmental evidence, purposefully investigated physical-resource outcomes or component-utilisation proxies. Synthesis was narrative, using explicit functional-unit and system-boundary rules, with a descriptive sensitivity analysis. Of 1,913 screened records, 45 database reports were assessed in full and 22 included; citation searching added three, giving 25 reports. Two quantified CO2e: a micro-costing estimate from three procedures, largely derived from expenditure-based factors, and a cumulative five-month saving from tray rationalisation. Nine reported purposefully investigated tray, instrument or implant-wastage outcomes; tray effects varied by platform and configuration. Fourteen reported revision or conversion component use, an indirect material-resource indicator strongly influenced by case mix. Excluding reports in which component use was incidental narrowed the evidence base but did not change the conclusions. Robotic arthroplasty can alter physical-resource use, but direction and magnitude depend on platform, procedure, service configuration and case mix. Direct environmental evidence is sparse, and current data do not show robotic arthroplasty to be environmentally superior or inferior to conventional surgery.