Health care facilities are major contributors of waste to landfills, with operating rooms estimated to assume 20–70% of this waste. With hip arthroscopy for femoroacetabular impingement (FAI) on the rise, it is important to understand its environmental impact and identify areas for greening practices. Given its minimally-invasive nature, we hypothesise overall arthroscopic waste per FAI patient case to be approximately 5 kg, with minimal biohazard waste. The purpose of this study was to determine the amount of waste produced in FAI procedures and understand the environmental impact of the procedure to aid us in developing greening practices. A single surgeon waste audit (with descriptive statistics) of five FAI hip arthroscopy procedures – categorised by: 1) normal/landfill waste; 2) recyclable cardboards and plastics; 3) biohazard waste; 4) sharp items; 5) linens; and 6) sterile wrapping – was performed in April 2015. The surgical waste (except laundered linens) from the five FAI surgeries totalled 47.4 kg, of which 21.7 kg (45.7%) was biohazard waste, 11.7 kg (24.6%) was sterile wrap, 6.4 kg (13.5%) was normal/landfill waste, 6.4 kg (13.5%) was recyclable plastics, and 1.2 kg (2.6%) was sharp items. There was an average of 9.4 kg (excluding laundered linens) of waste produced per procedure. Considerable waste, specifically biohazard waste, is produced in FAI procedures with an average of 9.4 kg of waste produced per procedure, including 4.3 kg of biohazard waste. In Canada (population 35.7 million), approximately 18 800 kg of waste (8600 kg of biohazard waste) is produced from an estimated 2000 FAI procedures performed every year. Additional recycling programs, reducing surgical overage, and continued adherence to proper waste segregation will be helpful in reducing waste production and its environmental burden. An emphasis on “green outcomes” is also required to demonstrate environmental responsibility and effectively manage and allocate finite resources

Aims. In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery. Methods. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through EMBASE, Medline, and PubMed libraries using two domains of terms: “orthopaedic surgery” and “environmental sustainability”. Results. A total of 13 studies were included in the final analysis. All papers studied the environmental impact of orthopaedic surgery in one of three areas: waste management, resource consumption, and carbon emissions. Waste segregation was a prevalent issue and described by nine studies, with up to 74.4% of hazardous waste being generated. Of this, six studies reported recycling waste and up to 43.9% of waste per procedure was recyclable. Large joint arthroplasties generated the highest amount of recyclable waste per procedure. Three studies investigated carbon emissions from intraoperative consumables, sterilization methods, and through the use of telemedicine. One study investigated water wastage and demonstrated that simple changes to practice can reduce water consumption by up to 63%. The two most common barriers to implementing environmentally sustainable changes identified across the studies was a lack of appropriate infrastructure and lack of education and training. Conclusion. Environmental sustainability in orthopaedic surgery is a growing area with a wide potential for meaningful change. Further research to cumulatively study the carbon footprint of orthopaedic surgery and the wider impact of environmentally sustainable changes is necessary. Cite this article: Bone Jt Open 2022;3(8):628–640

Introduction. The health sector contributes the equivalent of 4.4% of global net emissions to the climate carbon footprint. It has been suggested that between 20% and 70% of health care waste originates from a hospital's operating room, the second greatest component of this are the textiles used, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. Waste from common orthopaedic operations was quantified, the carbon footprint calculated, and cost of disposal assessed. A discussion of the circular economy of textiles, from the author of the textile guidance to the Green Surgery Report follows. Methods. The amount of waste generated from a variety of trauma and elective orthopaedic operations was calculated across a range of hospital sites. The waste was separated primarily into clean and contaminated, paper or plastic. The carbon footprint and the cost of disposal across the hospital sites was subsequently calculated. Results. Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double draping the patient contribute to increasing the quantity of waste. The cost to process waste vary widely between hospital sites, waste disposal contractors and the method of waste disposal. Conclusion. This study sheds new light on the environmental impact of waste produced in trauma and elective orthopaedic procedures. Mitigating the environmental impact of the operating room requires a collective drive for a culture change to sustainability and social responsibility. Each clinician can impact upon the carbon footprint of their operating theatre. Consideration should be given to the type of textiles used within the operating theatre