The World Health Organization has stated that the greatest threat to global health in the 21st century is climate change. Healthcare, and surgical procedures in particular, are the most energy-intensive and contribute directly to climate change through pollution, greenhouse gas emissions and toxic waste. With climate change a global priority, it is vital that hospitals reassess the environmental impact of these practices. Orthopaedic surgery in particular is reported to generate 60% more waste than other surgical specialties. It is the responsibility of healthcare professionals to provide environmentally sustainable surgical care. Sustainability principles utilise a `5R` strategy of reduce, reuse, recycle, rethink and research. The `5R` strategy to improve environmental sustainability has a broad role in orthopaedic surgery. Environmentally friendly practices in orthopaedic surgery encompass a surgical pathway that includes reducing energy consumption, using resources and raw materials wisely, reducing environmental pollution, and aiming to achieve the best outcomes for patients in an environmentally friendly way. This review summarises simple and effective environmentally friendly actions that can be implemented in orthopaedic surgery to contribute to a sustainable world through environmental responsibility.