Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: NC has provided consultancy services to Stryker Netherlands (Amsterdam), Zimmer-Biomet (Warsaw Indiana) and BodyCad (Naples USA). No other conflicts of interest have been recorded. 8. J Hand Microsurg. 2026 Mar 24;18(3):100448. doi: 10.1016/j.jham.2026.100448. eCollection 2026 May. Measuring the carbon cost of hand surgery: A single-centre observational study. Leijonberg L(1), Hindocha S(1)(2), Maheshwari K(1)(2). Author information: (1)Department of Plastic and Reconstructive Surgery, Bedfordshire Hospitals NHS Foundation Trust, United Kingdom. (2)Faculty of Health and Social Sciences, University of Bedfordshire, United Kingdom. PURPOSE: Healthcare contributes considerably to global greenhouse gas emissions, with operating theatres amongst the most energy-intensive hospital environments. While carbon footprints have been quantified for several surgical procedures, the environmental impact of hand surgery, characterised by high case volumes and short procedures, remains poorly studied. This study aims to quantify carbon emissions of hand surgery procedures. METHODS: This single-centre observational pilot study quantified the carbon emissions associated with hand surgery procedures performed during two half-day theatre lists at a UK NHS hospital. Data was collected under the Greenhouse Gas Protocol Scopes and emissions calculated using UK Government greenhouse gas conversion factors. Data collected included theatre electricity and heating, anaesthetic use, staff and patient transport, waste incineration, supply-chain emissions, and instrument sterilisation. RESULTS: Five trauma hand surgery cases were analysed. Case-level emissions ranged from 8.32 to 22.56 kg CO2. When combined at a list level, total emissions were substantial, reaching 311.36 kg CO2 and 285.30 kg CO2 per half-day list. Purchased electricity (Scope 2) was the largest contributor, followed by heating and anaesthetic gases (Scope 1). Scope 3 emissions were largely attributed to staff travel and single-use consumable supply-chain emissions, while waste disposal and reusable instrument sterilisation contributed comparatively little. CONCLUSIONS: Individual hand surgery procedures have a relatively low carbon footprint, but the cumulative emissions at list-level are large. Theatre energy use, heating and staff transport represent key targets for emission reduction. Interventions focusing on energy-efficient infrastructure, renewable energy, greener staff travel, and reduced reliance on single-use consumables may result in meaningful environmental benefits. Larger multicentre studies with improved energy metering are needed to refine estimates and guide sustainable surgical practice. CLINICAL RELEVANCE: Quantifying the carbon emissions associated with common hand surgery procedures may help hand surgery teams and healthcare organisations identify opportunities to reduce emissions. © 2026 Society for Indian Hand Surgery and Micro Surgeons. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. DOI: 10.1016/j.jham.2026.100448 PMCID: PMC13053682