Blog: Sustainability in Orthopaedic Surgery

By: Irrum Afzal, Vipin Asopa, Vipul Patel and Deiary Kader of the South West London Elective Orthopaedic Centre

Sustainability in surgery continues to gain great traction as global warming and climate change continue to become an ever-growing problem. The NHS is the largest single contributor of greenhouse gas emissions in the public sector and NHS England has an annual carbon footprint of 24.9 million tonnes of CO2e. The Carbon footprint of an operating department within a large UK hospital is estimated at 5,000 tonnes CO2e/year and a single operation at 150-250kg CO2e. In light of this, there is a significant challenge ahead to enable surgery to meet net zero carbon by 2045, in line with the Greener NHS strategy.

In May 2021, Professor Deiary Kader initiated a ‘Sustainability in Surgery’ initiative at the South West London Elective Orthopaedic Centre (SWLEOC). Professor Kader proposed to have ‘Sustainability’ added as an additional pillar to the existing Clinical Governance framework. The overall purpose of this initiative is to improve sustainability and to provide strategic direction and leadership to ensure there is environmental, financial, and social sustainability by promoting efficient and cost-effective use of healthcare resources while reducing variability of care and improving patient outcomes. This initiative was widely accepted by the centre and supported by SWLEOC Medical Director, Mr Vipul Patel and Director, Ms Mary Richardson.

Professor Kader initiated weekly meetings led and supported by Mr Vipin Asopa and Miss Irrum Afzal. Each department was invited to attend and share ideas to improve sustainability throughout SWLEOC. The Junior Clinical Research Fellows undertook local audits and reviewed the water usage, waste management and the flow of equipment and devices at SWLEOC. Dr Kar May Phoon and Mr Amit Sagi shared results from these audits at the National Orthopaedic Alliance (NOA) Annual Members’ Conference on 20 October 2021

As part of the conference, there were sessions covering sustainability. Mr Asopa organised a great presentation covering the pertinent domains of Environmental, Social and Economical Sustainability. The session was well attended and allowed members to share and take away different ideas.

Outside of SWLEOC, many other Trusts are also working on improving sustainability within the NHS. It was great to hear from Clare Mair and  Alicia Stanton of the Royal Orthopaedic Hospital (ROH) who shared initiatives they have embedded at their hospital to support social sustainability. It was noted from their presentations that supporting the community can go a long way for both employees and the local community.

Mr Patel discussed financial sustainability and explained the importance of reducing variation in healthcare and the importance of cost-effective use of healthcare resources, ethical purchasing, production and sourcing of healthcare products.

Mr Panos Gikas shared results of the NOA Environmental Sustainability questionnaire. Results of this questionnaire showed that members of the NOA are incredibly keen to work together with 100% of the respondents answering they would like to collaborate with other centres undertaking sustainability projects.

The take home message from all sustainability presentations was that if we work together, there is potential to have a sustainable NHS that meets the goal of being net zero carbon by 2045.

 Irrum Afzal, Vipin Asopa, Vipul Patel and Deiary Kader

South West London Elective Orthopaedic Centre ‘Sustainability in Surgery’ team’

Irrum graduated from Imperial College, London with a Distinction in Masters of Public Health (MPH) and was subsequently appointed to lead the orthopaedic research department under the supervision of the Academic Consultant Orthopaedic Surgeons at the South West London Elective Orthopaedic Centre. Irrum has comprehensive knowledge of quantitative, qualitative research, statistics and research governance and is a professional member to the Institute of Clinical Research (MICR) and the Research Quality Association (MRQA). Irrum uses this knowledge to deliver and manage multiple research and audits projects with the aim to improve evidence based medicine in Orthopaedics. Irrum has published in various peer-reviewed journals and often presents at national and international meetings. Irrum supports the SWLEOC Outcomes Database and Patient Reported Outcome Measures at SWLEOC. Irrum works closely with the consultants at SWLEOC and the management team providing them with regular outcome data. Irrum plays an active role in the Orthopaedic Research and Education Foundation and the Imperial College Alumni service.

Mr. Vipin Asopa is a Specialist Hip and Knee Surgeon at South West London Elective Orthopaedic Centre, Epsom. He was born and brought up in Southampton and went to King Edward VI School before going to Bristol University to study Medicine. He qualified in 1998 and went on to successfully complete his basic surgical training at the prestigious Hammersmith Hospital in 2002 before embarking on a PhD at Imperial College, London. In 2007, he started his basic surgical training on the Charing Cross North-West Thames rotation and became a Fellow of the Royal College of Surgeons (Trauma and Orthopaedic Surgery) in 2011. Mr. Asopa has completed a Sports Surgery fellowship in Adelaide, South Australia followed by another hip and knee joint surgery fellowship in Reading, Berkshire. He also completed a trauma fellowship in Wilhelminenspital, Vienna and has worked as a substantive consultant in North-Middlesex University Hospital between 2014-2019, before moving to SWLEOC Academic Surgical Unit. His research interests include the use of stem-cell therapy, using artificial intelligence to improve patient outcomes following surgery and sustainability in Orthopaedics.

First appointed as Consultant 1999 and Consultant at Epsom and St Helier since 2001.

Directorate Quality Lead for Surgery, Epsom & St Helier April 2016 – onwards.

Regional Clinical Co-ordinator, National Joint Registry, Jan 2016 – onwards.

Member, BOA Clinical Commissioning Guidance Development Group – 2012-14.

Clinical Lead for Trauma and Orthopaedics, Epsom & St Helier, 2008-2012.

Reviewer for “Shoulder and Elbow” journal and “Bone and Joint Journal”

Mr Patel was instrumental in setting up the Shoulder and Elbow Service at St Helier Hospital and introducing shoulder and elbow surgery to SWLEOC (South West London Elective Orthopaedic Centre).

Mr Patel is passionate about training and have set up a BOA clinical leaders’ fellowship for senior trainees. His research interests include shoulder conditions such as rotator cuff tears, frozen shoulder and shoulder arthroplasty. He have collaborated on multi-centre trials on rotator cuff repair and arthroscopic subacromial decompression. Mr Patel’s work has been presented at national and international meetings and published in peer-reviewed journals.

Professor Kader is a fellowship trained knee and a sport medicine surgeon with extensive experience in knee ligament reconstruction, primary/revision knee arthroplasty, patellofemoral joint instability and multiligament reconstruction.

After finishing his type one Specialist Registrar training in Scotland and knee fellowship in Sydney and Newcastle in 2005, he was appointed as consultant trauma and orthopaedic surgeon in the QEH NHS trust in Gateshead and Newcastle Nuffield private hospital where he worked for more than ten years. Since 2010 professor Kader has been dedicating a significant amount of his time to humanitarian work with NGMV medical charity ( and more recently with the International Committee of the Red Cross (ICRC) ( at their war wounded trauma reconstruction centre in Tripoli/Lebanon.

He is also a visiting professor in the Faculty of Health and Life Sciences in Northumbria University and a director of OASIR Research group ( In the past 8 years he has developed an extensive research interest in patellar instability and tendinopathy. He has published more than 88 scientific papers, book chapters and articles. He is also the co-author of some of the best selling Postgraduate Orthopaedic books in the UK.