A New Perspective on Operating Room Noise Hazard During Adult Reconstruction and Joint Replacement

Background Prolonged intraoperative noise, especially within Adult Reconstruction & Joint Replacement (ARJR), poses a long-term risk of hearing loss among surgical personnel–particularly surgeons. Due to routine involvement of power tools in ARJR procedures, orthopedic surgeries frequently exceed a sound level of 100 dB. In addition, surgical space suits, which are commonly worn during arthroplasties, are equipped with overhead fans, producing a constant noise of ~60 dB at surgeons’ ear level. With introduction of impactors, such as Kincise and Orthodrive, the modern Total Hip Replacements (THRs) in some cases have been shown to reach over 120 dB and being notably louder than THRs without an impactor. Noteworthy, THRs without an impactor have been reported to be quieter than Total Knee Replacements (TKRs), which may be attributed to more significant mallet use during the latter. Purpose To stratify the occupational noise risk that new technology poses as compared to more traditional procedures. In addition, differences in surgeons’ and circulators’ sound exposures will be evaluated. Materials and methods We examined OR personal noise exposure during 26 surgeries (from timeout to debrief), including TKRs, THRs, and THRs using an impactor. Sound data including: Lcpeak (peak sound pressure level), L Avg (average sound level over the sampling period), and TWA (time-weighted average exposure) was collected in decibels (dB) via a personal noise Dosimeters, one secured onto the surgeon (study group) prior to scrubbing in, and the other onto the circulator (control group). Each measurement was performed in accordance with Occupational Safety & Health Administration's (OSHA) recommendations for monitoring sound exposure. The data statistical analysis was performed with descriptive statistics and the nonparametric U Mann-Whitney test in R-Studio. The correlations between pairs of parameters were analyzed using Pearson's correlation coefficient, with statistical significance set at ≤0.05. Results During impactor-assisted THR the surgeon experienced L Avg values of 81 dB (p<0.001), peak dB of 137 dB (p=0.003), and TWA of 72 dB (p<0.001). Compared to the circulators who experienced L Avg of 74, peak dB of 123 dB, and TWA of 64 dB. During TKRs the surgeons experienced L Avg values of 83 dB (p<0.001), peak dB of 135 dB (p=0.056), and TWA of 73 dB (p<0.001). Compared to the circulator's values of L Avg of 74 dB, peak dB of 129 dB, and TWA of 64 dB. The highest recorded noise was during a TKR at 141.9 dB. Conclusion During impactor-assisted THRs noise intensity for the surgeon was 5x greater than those of the circulator. During TKRs, noise intensity is approximately 8x greater for the surgeon than those of the circulator. OSHA reports prolonged (≥15 min) exposure of ≥115 dB may lead to hearing loss, and noise exposure we recorded significantly exceeds those recommendations. Moreover, the impact noises exceeding 140 dB exceed OSHA's recommendations, while TWA and L Avg remain below.