Clean Joints, Clean Planet: A Review of Literature on Sustainable Practices in Orthopaedic Joint Replacements.

The healthcare sector generates significant global greenhouse gas emissions, and the orthopaedic operating theatre is among the most resource-intensive environments within any hospital. Hip and knee arthroplasty produce considerable waste and carbon emissions with each procedure. This review evaluates global sustainable practices adopted for hip and knee joint replacement surgeries and identifies practical opportunities to reduce environmental impact while preserving patient safety and quality of care. A narrative review rather than a systematic review of literature of major databases was performed, and evidence concerning energy efficiency, reusable instruments, waste management and implant production and recycling was analysed. Operating theatres consume significantly more energy than other hospital areas, but occupancy-based ventilation can reduce heating, ventilation and air conditioning (HVAC) energy consumption, as well as the use of light-emitting diode (LED) lighting and shutdown protocols. Sterilisation accounts for the majority of emissions attributed to reusable instruments, while the rationalisation of surgical trays and reusable surgical gowns and drapes can also reduce CO₂ emissions. Each arthroplasty generates a significant amount of waste. The implant manufacturer heavily contributes to procedural emissions, and the global recycling of explanted implants could yield substantial environmental and financial savings. Sustainable arthroplasty is both achievable and cost-saving. Energy conservation, reusable instruments, better waste segregation, implant recycling, and evidence-based patient selection can help reduce the environmental and economic burden of joint replacement surgery. Furthermore, collaboration between surgeons, healthcare institutions and the healthcare industry is essential to balance high-quality patient care with sustainability.