Carbon footprint of hip arthroscopy in non-professional athletically active patients: a patient-level analysis of surgical variables, anesthesia type, and functional outcomes

Abstract

This study aimed to quantify the patient-level carbon footprint of hip arthroscopy in athletically active patients and to identify its structural determinants and relationship with functional outcomes. A retrospective cohort study was conducted on 58 athletically active patients who underwent primary hip arthroscopy for femoroacetabular impingement between March 2023 and March 2025 at a tertiary center. Carbon emissions (kgCO(2)e) were calculated per patient across six domains: operating room energy, surgical materials, sterilization, anesthesia, patient transportation, and waste management. Functional outcomes were assessed using the International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sport at 12 months. Multivariable regression identified independent predictors of total carbon footprint and carbon efficiency. The mean total carbon footprint was 75.14 +/- 24.18 kgCO(2)e per patient. Transportation (52.9%) and surgical materials (29.6%) were the largest contributors. Patient travel distance (beta = 0.797, P < .001), operation time (beta = 0.860, P = .003), and visit count (beta = 7.187, P = .009) were significant predictors, with the structural model explaining 77.7% of variance (adjusted R-2 = 0.751). Material-related emissions differed significantly between 2 versus >= 3 anchor groups (P = .022), although the 2-anchor subgroup (n = 4) should be interpreted as hypothesis-generating. Higher preoperative iHOT-12 scores (beta = 0.005, P = .017) predicted better carbon efficiency, while revision surgery predicted poorer efficiency (beta = -0.171, P = .038). In this exploratory single-center study, the carbon footprint of hip arthroscopy was predominantly driven by patient transportation and surgical materials. These findings suggest that optimizing travel logistics, operative efficiency, and material selection may reduce environmental impact without compromising clinical outcomes, although validation in larger multicenter cohorts is warranted.