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

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 (kgCO₂e) 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 kgCO₂e per patient. Transportation (52.9%) and surgical materials (29.6%) were the largest contributors. Patient travel distance (β = 0.797, P < .001), operation time (β = 0.860, P = .003), and visit count (β = 7.187, P = .009) were significant predictors, with the structural model explaining 77.7% of variance (adjusted R2 = 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 (β = 0.005, P = .017) predicted better carbon efficiency, while revision surgery predicted poorer efficiency (β = −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. Highlights What is known about this subject: Healthcare operations generate 4%–5% of global greenhouse gas emissions, with orthopedic surgery being a primary source due to energy-intensive equipment and high consumable turnover.While previous life cycle assessments have quantified emissions for knee and hip arthroplasty, the environmental burden of hip arthroscopy, a procedure involving specialized anchors and distinct anesthesia protocols, remains unexplored.The relationship between a procedure’s environmental cost and the clinical value it returns (functional improvement) has not been previously modeled in sports medicine. What this study adds to existing knowledge: This study provides, to our knowledge, the first patient-level carbon footprint analysis for hip arthroscopy, revealing a mean emission of 75.14 kgCO₂e, primarily driven by patient transportation (52.9%) and surgical materials (29.6%).It demonstrates that specific surgical choices, such as using suture anchors instead of metal anchors and minimizing anchor count, significantly reduce material-related emissions without affecting 12-month functional outcomes (International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score).The introduction of the “Carbon Efficiency” metric suggests that patients with higher baseline function may derive a greater clinical return per unit of carbon emitted, while revision surgery substantially diminishes environmental efficiency; however, this association should be interpreted as descriptive rather than causal.The findings provide a data-driven roadmap for “Green Sports Medicine,” highlighting that optimized travel logistics, surgical efficiency, and judicious material selection can decouple clinical excellence from environmental impact.