To The Editor:
Dr. Horwitz and his colleagues are to be commended for their study "The Economic Impact of Reprocessing External Fixation Components" (2007;89:2132-6). The health-care sector comprises 16% of our gross domestic product. Twenty-five percent of hospital waste comes from the operating room, and much of that is red bag waste— i.e., waste that is ten times more expensive to dispose of. Because of our need for fixation devices, orthopaedics has large resource needs.
It has struck me as inane that drill bits or used screws are discarded. Dr. Horwitz et al. recognized the benefits of a product's "life-cycle assessment." They proposed that the manufacturer has a responsibility for disposing of the products that they produce, and they created an opportunity for themselves as well as for the producer. By repurchasing a product from the manufacturer at a reduced cost, they saved money and diverted the product from their most expensive waste stream. Stryker, the company in question, avoided losing business to a third-party reprocessor by recycling components—a process that uses less energy than virgin product production.
None need to be told of the concern regarding the increasing costs of orthopaedic implants. This paper shows that if we start asking our manufacturing colleagues questions, we can create opportunities to decrease our implant costs through recycling programs. Although not mentioned in the paper, such programs can also lead to decreased waste costs. When we look at new products, we should ask manufacturers to reprocess or recycle old products, provide autoclavable containers, and use recycled metals in their products.
New developments in orthopaedics are exciting, but it seems that we are moving away from designing reusable items and moving toward more single-use items. None wish to compromise results with substandard equipment, but does that mean that each implant or product needs to be used only once? It is my hope that articles such as this will help us to understand the economic and environmental impact of surgery and lead us to make it a more sustainable field.