Greening orthopaedic surgery: Carbon footprint, waste generation, environmental impact, and mitigation strategies.

Abstract

<h4>Background</h4>Orthopaedic surgery is among the most resource-intensive areas of healthcare, generating substantial waste, energy consumption, and carbon emissions. Operating rooms contribute disproportionately to a hospital's environmental footprint due to their high energy loads, extensive use of consumables, and complex supply chains. Despite rising global attention to sustainable healthcare, evidence specific to orthopaedic practice remains fragmented.<h4>Objectives</h4>This narrative review synthesises current evidence on the environmental impact of orthopaedic surgery, identifies major contributors to waste and carbon footprint, and outlines effective mitigation strategies applicable at institutional, clinical, and policy levels.<h4>Methods</h4>A structured search was conducted using MeSH and keyword combinations related to carbon footprint, sustainability, and orthopaedic surgery. Eligible studies included original research, reviews, and institutional reports assessing waste generation, CO₂e emissions, energy use, or sustainability interventions. Two reviewers independently screened studies and performed thematic synthesis.<h4>Results</h4>Orthopaedic procedures generate 4-10 kg of waste per case, with plastics comprising nearly half. Life-cycle assessments report procedure-level emissions ranging from 28 to >150 kg CO₂e, highest in arthroplasty and spine surgery. Major footprint contributors include OR energy use, single-use consumables, implant manufacturing, sterilisation, and anaesthetic gases. Evidence demonstrates that tray optimisation, reusable systems, improved waste segregation, low-flow anaesthesia, and environmentally preferable procurement can reduce environmental impact by 20-70 %. However, methodological heterogeneity and limited data from low-income settings hinder the benchmarking process.<h4>Conclusion</h4>Orthopaedic surgery carries a significant environmental burden; however, multiple evidence-based strategies can substantially reduce its environmental footprint. Standardised assessment methods and broader global data are essential to guide sustainable surgical practice.