By Martyn J Parker 
Consultant Orthopaedic Surgeon, Department of Orthopaedics, Peterborough City Hospital, North West Anglia NHS Foundation Trust

Corresponding author e-mail: [email protected]

Published 18th November 2021

How can I could change my orthopaedic practice to make my own contribution to reducing the consequences of climate change? I believe that if we could all share our own experiences and together use our collective influences, we could all make our own small differences. Listed below are the changes I have made and those changes that I would still like to make with the assistance of the orthopaedic community. 

1.    Virtual outpatients

COVID was the catalyst for this change. At the start of the COVID outbreak, an immediate decision was made that the majority of my outpatient follow-up appointments for my hip fracture patients would be done by telephone. Following discharge, the patient is given written information of the operative procedure undertaken and information stating that the follow-up will be by a phone call at six weeks after discharge. Patients not willing to accept this can ring and request a clinic appointment. Any patient with any concerns at the six-week phone call follow-up, is offered an x-ray at their nearest hospital which may be a local community hospital. This is then reviewed by myself, and a second phone call follow-up completed. 

This policy has been in operation since April 2020. Each week about 15 patients have a telephone follow up and approximately two or three are seen in the clinic. No patient has been adversely effected by this change in policy. The environmental savings are incurred by the reduced travel of patients and use of the ambulance staff. An additional benefit is a considerable cost savings to the health service. I can see no reason why such a policy cannot become the normal for most hospital discharges and to be extended to include the majority of arthroplasty surgery follow-up appointments. 

2.    Arrange X-rays locally

If an X-ray is required then the patient should be sent to the nearest X-ray department to reduce travel. Regrettably, this may be hampered by different health regions using a different digital X-ray systems. This lack of a joined up system does not equate with a National Health Service. The orthopaedic community needs to advocate for a single requesting and access system for all X-rays taken at any UK health service facility. Such a service would be even more valuable for a regional centre treating patients from further afield. 

3.    Home working and virtual learning

Another consequence of COVID is the ability to undertake some of our work and learning activities from home and thereby reduce unnecessary travel.

4.    Changes to surgical practice

Over the years, there has been a progressive trend to a greater use of disposable items. We need to exert pressure, as an orthopaedic community, to reverse this trend. For example, most bone drills can be repeatedly used with sharpening as required and guide wires can be reused unless they become bent. At present many of these and now provided as single use. This trend to single use instruments is led by the manufacturing and implant companies and is used by them as a method of generating additional revenue. We need as a collective group to say that such practices are unacceptable and to return to using mainly re-usable instruments. An additional surgical option is the closure of wound with absorbable subcuticular sutures. This avoids the need for the patient to attend or have a district nurse visit for removal of the clips.

I would welcome the comments of other orthopaedic surgeons to see how we can collectively make our own small contribution to reducing the environmental consequences of our actions.