Reducing/Recycling Product Packaging Materials and Implementing Sustainable Development Goal Initiatives in Orthopedic Artificial Joint Manufacturing and Sales Companies: A Questionnaire-Based Survey.

Background and objective Orthopedic surgery, particularly joint replacement, involves the use of many implants, resulting in a large amount of product packaging waste. To date, no study has surveyed artificial joint manufacturers on the recycling and reduction of packaging materials and their Sustainable Development Goal (SDG) initiatives. This questionnaire survey aimed to identify the current status of orthopedic artificial joint manufacturers in terms of implementing SDG initiatives. Material and methods The questionnaire survey involved 16 companies that sell artificial joints in Japan. The questionnaire prepared on a Google Form was sent to the persons in charge of each company and their answers were analyzed. Questions were asked about raw materials for packaging materials, display of the recycling symbols on packaging materials, attachment of paper instruction manuals, disposing and recycling of unused artificial joint prosthesis products and old surgical instruments, each company's efforts to reduce the amount of packaging materials, and the corporate structure and commitments to the SDGs of each company. Results Fourteen companies responded to the questionnaires (response rate: 85.7%). Paper, polyethylene, and polyethylene terephthalate were found to be the common packaging materials. The recycle symbol display rates on packaging materials were as low as 14%, except for the plastic containers (43%). Paper instruction manuals enclosed with products are being phased out, and instruction manuals will now be available electronically. Recycling of unused products and their packaging materials at the time of disposal was insufficient. Similarly, recycling of old surgical instruments at disposal was insufficient, as were manufacturers' efforts to reduce product packaging materials. Only six (43%) and eight companies (57%) were working to reduce the use of paper and plastic packaging materials, respectively. However, some manufacturers have made efforts to design their products to reduce the amount of paper and plastics used as much as possible from the early stage of the product development process. The number of staff in charge of SDGs in Japan is small, whether in Japanese or foreign companies and specialized or integrated enterprises. When the headquarters of foreign companies were included, the number was relatively large. Regarding external consultants and advisors on SDGs, there were none in the country, and only four companies, including those with overseas headquarters, have contracted consultants. Though eight companies disseminated their general sustainability information on their websites, only two companies had web pages describing their current status and future plans for reducing the amount of packaging materials used in prosthetic joint products. Conclusions At present, the rate of display of recycling symbols on the packaging materials of joint prosthesis products is low. Although there are differences among manufacturers, the rates of reducing/recycling packaging materials and recycling unused products and old surgical instruments at disposal are generally insufficient. There is little human-resource investment in the SDGs, especially in Japan. Though most companies furnished information on their websites regarding sustainability in general, few companies specifically provided information on the reduction of materials used in product packaging.