Abstract Aim Trauma and orthopaedic (T&O) surgery relies heavily on medical devices of different unrecyclable materials. This specialty generates significant metalwork wastage through implants, screws, nails and plates, placing a large economical strain on healthcare. Finding sustainable solutions is vital given globally increasing life expectancies and heavier dependency on invasive interventions, such a knee or hip arthroplasties. Our primary outcome is to quantify implant wastage across the literature, and secondarily investigate the associated costs. Method PRISMA guidelines were followed in the design, conduct and reporting. We searched through three databases (Scopus, PubMed and Embase) using MeSh terms including “implant waste” and “trauma and orthopaedic surgery”. We included observational and randomised controlled trials reporting patients undergoing T&O surgery, where the wastage or associated costs was provided. Results Our final analysis included 15 articles, screened from a total of 2,145 articles. 25,025 procedures were included, but there was limited and unmatched data. Implant waste ranged, occurring in 0.8%-25.1% procedures and costing on average $167,139.13. Screws and nails were amongst the most wasted material (up to 91% and 48% respectively), however intramedullary nails were the greatest cost contributor, making up to 47.6% of total wastage cost. Up to 95% of waste was attributable to human error. Conclusions Balancing implant wastage and hospital costs with patient safety is a challenge for many T&O subspecialties. The largest factors contributing to waste were human factors, such as surgeon or staff error, miscommunication and changing decision. We hope this review will inform future guidelines in encouraging implant waste mindfulness.