Hotter global temperatures and increasingly variable climate patterns negatively affect human health, with a wide recognition that climate change is a major global health threat. Human activities, including those conducted in the orthopaedic operating room (OR), contribute to climate change by generating greenhouse gases that trap infrared radiation from the earth's surface. This review provides an overview of the environmental effect of the orthopaedic OR and efforts to address environmental sustainability in the OR. These concepts are presented with a particular focus on patient safety and cost savings because roll-out of these efforts must be conducted with a pragmatic and patient-centered focus. Orthopaedic surgeons have an opportunity to lead efforts to improve environmental sustainability in the OR and thus contribute to efforts to curb climate change.