Labelling of Fluids in the Sterile Field During Orthopaedic Surgery: A Quality Improvement Initiative.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

Conflict of interest statement: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. 8. Cureus. 2026 Jul 10;18(7):e112414. doi: 10.7759/cureus.112414. eCollection 2026 Jul. Clean Joints, Clean Planet: A Review of Literature on Sustainable Practices in Orthopaedic Joint Replacements. Borse AM(1), Merchant J(2), Bhave VS(3), Borse NM(4), Patil V(1). Author information: (1)Department of Trauma and Orthopaedics, Northern Care Alliance NHS Foundation Trust, Oldham, GBR. (2)Department of Trauma and Orthopaedics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR. (3)Medicine, Independent Researcher, Oldham, GBR. (4)Department of Orthopaedics and Traumatology, Maharashtra University of Health Sciences, Islampur, IND. The healthcare sector generates significant global greenhouse gas emissions, and the orthopaedic operating theatre is among the most resource-intensive environments within any hospital. Hip and knee arthroplasty produce considerable waste and carbon emissions with each procedure. This review evaluates global sustainable practices adopted for hip and knee joint replacement surgeries and identifies practical opportunities to reduce environmental impact while preserving patient safety and quality of care. A narrative review rather than a systematic review of literature of major databases was performed, and evidence concerning energy efficiency, reusable instruments, waste management and implant production and recycling was analysed. Operating theatres consume significantly more energy than other hospital areas, but occupancy-based ventilation can reduce heating, ventilation and air conditioning (HVAC) energy consumption, as well as the use of light-emitting diode (LED) lighting and shutdown protocols. Sterilisation accounts for the majority of emissions attributed to reusable instruments, while the rationalisation of surgical trays and reusable surgical gowns and drapes can also reduce CO₂ emissions. Each arthroplasty generates a significant amount of waste. The implant manufacturer heavily contributes to procedural emissions, and the global recycling of explanted implants could yield substantial environmental and financial savings. Sustainable arthroplasty is both achievable and cost-saving. Energy conservation, reusable instruments, better waste segregation, implant recycling, and evidence-based patient selection can help reduce the environmental and economic burden of joint replacement surgery. Furthermore, collaboration between surgeons, healthcare institutions and the healthcare industry is essential to balance high-quality patient care with sustainability. Copyright © 2026, Borse et al. DOI: 10.7759/cureus.112414 PMCID: PMC13453290