Reviews: Review Article

Environmental Sustainability in Orthopaedic Surgery

Engler, Ian D. MD; Curley, Andrew J. MD; Fu, Freddie H. MD; Bilec, Melissa M. PhD

From the Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA (Engler, Curley, and Fu), and the Department of Civil and Environmental Engineering, Mascaro Center for Sustainable Innovation, University of Pittsburgh, Pittsburgh, PA (Bilec).

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Engler, Curley, Fu, and Bilec.

Journal of the American Academy of Orthopaedic Surgeons 30(11):p 504-511, June 1, 2022. | DOI: 10.5435/JAAOS-D-21-01254

Abstract

Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery.