WaSTE: a multicentre audit of waste segregation practices in elective knee and hip arthroplasty

Aims: Arthroplasty generates the most waste among the sub-specialties of orthopaedic surgery. Infectious waste generates ten times more CO2 than recycled waste, and over 90% of it is misallocated. This multicentre study aimed to quantify waste from primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) across UK NHS trusts, guiding strategies for waste reduction and improved segregation. Methods: Data were collected prospectively from ten UK centres over six months between October 2023 and April 2024, covering at least ten arthroplasty cases per centre. Waste was categorized and weighed across six streams (infectious, offensive, recycling, general, sharps, and linen). Data on scrubbed personnel, drapes, implant brand, and intraoperative complications were also collected. Results: Data from 222 procedures (92 THAs, 130 TKAs) revealed significant differences in total waste production across centres (p < 0.001). THAs produced a mean of 14.8 kg waste, while TKAs generated 13.6 kg. Only 5/10 trusts utilized the offensive waste stream. Implant brand, number of scrubbed personnel, and reusable drapes were predictors of increased waste production on unadjusted univariate analysis; multivariable linear regression analysis showed local centre practice was the only significant predictor of waste production. Conclusion: Local waste management practices were the strongest predictors of waste production, underscoring need for standardization, education, and adherence to best practices. The use of offensive waste streams eliminated infectious waste, supporting a shift towards less carbon-intensive disposal. Adherence to established national guidelines is required to reduce the quantity of infectious waste and reduce the carbon footprint of arthroplasty surgery. Implementing offensive waste streams can reduce carbon intensity significantly. Addressing centre-specific policies, adhering to national guidance, and industry collaboration are essential for minimizing arthroplasty waste. Cite this article: Bone Jt Open 2026;7(4):499–506.