Total Knee Arthroplasty With Robotic Surgical Assistance Results in Less Physician Stress and Strain Than Conventional Methods

Haffar, Amer; Krueger, Chad A.; Goh, Graham S.; Lonner, Jess H.

doi:10.1016/j.arth.2021.11.021

Cited by 23 publications

(12 citation statements)

References 30 publications

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“…However, we propose that institutions include a surgeoncentric ergonomic assessment during the quality assessment of novel surgical instruments and workflows before their implementation. Such assessment could be achieved through ergonomic film review, wearable devices to measure physiologic strain, or survey of surgeons' perceptions [14,18,31,32,60].…”

Section: Discussion Of Key Findingsmentioning

confidence: 99%

“…Ergonomic assessment revealed several sources of biomechanical stress in the upper extremities [26,34,48,50] and spine [31,43,[58][59][60]. Orthopaedic surgeons commonly experienced upper extremity "fatigue" while performing surgery; for example, a reduction in maximal grip force, driving torque, and push force after performing fixation of femoral fractures [34].…”

Section: Ergonomic Assessment and Interventionsmentioning

confidence: 99%

“…Two studies reported a potential benefit of robotic-assisted TKA with regard to cervical, thoracic, and lumbar strain compared with manual TKA [31,60]. Common spine surgeries are associated with poor posture, with one study reporting that the proportion of operative time spent in a nonneutral (slouched) spine position while performing cervical and lumbar spine surgery was 39.9%, 58.9%, and 38.5% [43].…”

Section: Ergonomic Assessment and Interventionsmentioning

confidence: 99%

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High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review

Vasireddi,

Shah

et al. 2023

Clin Orthop Relat Res

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Background The Centers for Disease Control defines work-related musculoskeletal disorders as disorders of the nerves, muscles, tendons, joints, spinal discs, and cartilage that are caused or exacerbated by the environment or nature of work. Previous meta-analyses have characterized work-related musculoskeletal disorders among interventionists, general surgeons, and other surgical subspecialties, but prevalence estimates, prognosis, and ergonomic considerations vary by study and surgical specialty. Questions/purposes (1) What is the career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons? (2) What is the treatment prevalence associated with work-related musculoskeletal disorders in orthopaedic surgeons? (3) What is the disability burden of work-related musculoskeletal disorders in orthopaedic surgeons? (4) What is the scope of orthopaedic surgical ergonomic assessments and interventions? Methods A systematic review of English-language studies from PubMed, MEDLINE, Embase, and Scopus was performed in December 2022 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that presented prevalence estimates of work-related musculoskeletal disorders or assessed surgical ergonomics in orthopaedic surgery were included. Reviews, case reports, gray literature (conference abstracts and preprints), and studies with mixed-surgeon (nonorthopaedic) populations were excluded. The search yielded 5603 abstracts; 24 survey-based studies with 4876 orthopaedic surgeons (mean age 48 years; 79% of surgeons were men) were included for an analysis of work-related musculoskeletal disorders, and 18 articles were included for a descriptive synthesis of ergonomic assessment. Quality assessment using the Joanna Briggs Institute Tool revealed that studies had a low to moderate risk of bias, largely because of self-reporting survey-based methodology. Because of considerable heterogeneity and risk of bias, prevalence outcomes were not pooled and instead are presented as ranges (mean I2 = 91.3%). Results The career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons ranged from 37% to 97%. By anatomic location, the prevalence of work-related musculoskeletal disorders in the head and neck ranged from 4% to 74%; back ranged from 9% to 77%; forearm, wrist, and hand ranged from 12% to 54%; elbow ranged from 3% to 28%; shoulder ranged from 3% to 34%; hip and thigh ranged from 1% to 10%; knee and lower leg ranged from 1% to 31%; and foot and ankle ranged from 4% to 25%. Of orthopaedic surgeons reporting work-related musculoskeletal disorders, 9% to 33% had a leave of absence, practice restriction or modification, or early retirement, and 27% to 83% received some form of treatment. Orthopaedic surgeons experienced biomechanical, cardiovascular, neuromuscular, and metabolic stress during procedures. Interventions to improve orthopaedic surgical ergonomics have been limited, but have included robotic assistance, proper visualization aids, appropriate use of power tools, and safely minimizing lead apron use. In hip and knee arthroplasty, robotic assistance was the most effective in improving posture and reducing caloric expenditure. In spine surgery, proper use of surgical loupes was the most effective in improving posture. Conclusion Although the reported ranges of our main findings were wide, even on the low end of the reported ranges, work-related musculoskeletal disability among orthopaedic surgeons appears to be a substantial concern. We recommend that orthopaedic residency training programs incorporate surgical ergonomics or work injury lectures, workshops, and film review (alongside existing film review of surgical skills) into their curricula. We suggest hospitals engage in shared decision-making with surgeons through anonymous needs assessment surveys to implement wellness programs specific to surgeons’ musculoskeletal needs. We urge institutions to assess surgeon ergonomics during routine quality assessment of novel surgical instruments and workflows. Level of Evidence Level III, prognostic study.

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Section: Discussion Of Key Findingsmentioning

confidence: 99%

Section: Ergonomic Assessment and Interventionsmentioning

confidence: 99%

Section: Ergonomic Assessment and Interventionsmentioning

confidence: 99%

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High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review

Vasireddi,

Shah

et al. 2023

Clin Orthop Relat Res

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“…The ergonomics and energy expenditure with other robotic systems cannot be inferred from our data. A similar study found that the surgeon studied experienced less musculoskeletal strain and cardiorespiratory stress using the Rosa Knee System (Zimmer Biomet, Warsaw, IN) for robotic‐assisted TKA [18]. Despite finding statistically significant differences for various cardiorespiratory and ergonomic metrics, it is not certain whether these differences are clinically meaningful.…”

Section: Discussionmentioning

confidence: 99%

UKA with a handheld robotic device results in greater surgeon physiological stress than conventional instrumentation

Haffar

Krueger

Goh

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposePoor ergonomics and acute stress can impair surgical performance and cause work‐related injuries. Robotic assistance may optimize these psychophysiological factors during UKA. This study compared surgeon physiologic stress and ergonomics during robotic‐assisted UKA (rUKA) and conventional UKA (cUKA). MethodsCardiorespiratory and postural data from a single surgeon were recorded during 30 UKAs, (15 rUKAs, 15 cUKAs). Heart rate (HR), HR variability, respiratory rate (RR), minute ventilation and calorie expenditure were used to measure surgical strain. Intraoperative ergonomics were assessed by measuring flexion/extension/rotation of the neck and lumbar spine, and shoulder abduction/adduction. ResultsMean operative time was 32.0 ± 7 min for cUKA and 45.9 ± 9 min for rUKA (p < 0.001). Mean neck flexion was − 23.4° ± 13° for rUKA and − 49.1° ± 18 for cUKA (p < 0.001), while mean lumbar flexion was − 20.3° ± 30° for rUKA and − 0.4° ± 68° for cUKA (p = 0.313). Mean lumbar flexion was similar; however, a significantly greater percentage of time was spent in lumbar flexion > 20° during cUKA. Bilateral shoulder abduction was significantly higher for rUKA. Mean calorie expenditure was 154 cal for rUKA and 89.1 cal for cUKA (p < 0.001). Mean HR was also higher for rUKA (88.7 vs. 84.7, p = 0.019). HR variability was slightly lower for rUKA (12.4) than for cUKA (13.4), although this did not reach statistical significance (p = 0.056). No difference in RR or minute ventilation was observed. ConclusionrUKA resulted in less neck flexion but increased shoulder abduction, heart rate, and energy expenditure. The theoretical ergonomic and physiologic advantages of robotic assistance using a handheld sculpting device were not realized in this study. Level of evidenceII.

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“…A study of Kayani,et al [26] also showed less inflammatory response of the patient after surgery. Another studies have shown surgeon advantages with better ergonomics during the procedure and lower caloric waste [4,27].…”

Section: Reviewmentioning

confidence: 99%

Robotically Assisted Total Knee Arthroplasty - Literature Review

Vinicius¹,

Fernandes²

2022

J Musculoskelet Disord Treat

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Despite the evolution in implant design, surgical technique, rehabilitation and better medical training, a great number of patients are not satisfied with the final result of Total Knee Arthroplasty (TKA). The conventional TKA technique could result in a high number of outliers in limb alignment and are related to a high rate of residual symptoms. Robotically assisted (RA) surgery was introduced to improve these results. Recent studies showed this technique is associated to lower costs, better accuracy in implant placement and limb alignment, improvement in function and patient satisfaction. RA technique is also related to less blood loss, less bone resection and smaller aggression to soft tissues. Besides that, this brings better ergonomics to the surgeon with less caloric waste. In this way, by the benefits showed, the adhesion to the robotic surgery must be encouraged.

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Total Knee Arthroplasty With Robotic Surgical Assistance Results in Less Physician Stress and Strain Than Conventional Methods

Cited by 23 publications

References 30 publications

High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review

High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review

UKA with a handheld robotic device results in greater surgeon physiological stress than conventional instrumentation

Robotically Assisted Total Knee Arthroplasty - Literature Review

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