Wrist at risk? – Considerations derived from a novel experimental setup to assess torques during hip reaming with potential implications on the orthopedic surgeons’ health

Lorenz, Mario; Pelliccia, Luigi; Werner, Michael; Scholze, Mario; Klimant, Philipp; Heyde, Christoph‐E.; Klima, Stefan; Hammer, Niels

doi:10.1016/j.jmbbm.2020.104160

Cited by 3 publications

(11 citation statements)

References 13 publications

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“…In addition, 4 studies assessed exertional burden of the upper extremity in orthopaedic surgeons 13,14,16,17 (Table II). Ferrari et al 13 demonstrated that with broaching during total hip arthroplasty, manual impactions were associated with a high level of fatigue and activation of the forearm muscles that can be reduced with automated impaction.…”

Section: Resultsmentioning

confidence: 99%

“…Hsiao et al 14 showed that after inserting 8 bone screws during femoral fracture fixation, the maximal grip force, driving torque, and push force were reduced by approximately 29%, 20% and 23%, respectively. Lorenz et al 16 further presented a biomechanical model of the wrist during hip reaming, which averaged peak torques along the reamer axis at 1.5 to 1.8 Nm while it was pushed into the acetabula. Increased peak torques were associated with higher feed rates, and peak force experienced by the joint in case of sudden blockage was estimated at 37 N 16 .…”

Section: Resultsmentioning

confidence: 99%

“…Lorenz et al 16 further presented a biomechanical model of the wrist during hip reaming, which averaged peak torques along the reamer axis at 1.5 to 1.8 Nm while it was pushed into the acetabula. Increased peak torques were associated with higher feed rates, and peak force experienced by the joint in case of sudden blockage was estimated at 37 N 16 . Finally, Mahmood et al 17 reported a vibrational magnitude of 11.3 ± m/s 2 (weighted root mean squared) when using hand-operated saws, which correlated with an exposure action value of 23 minutes and exposure limit value of 1 hour and 33 minutes.…”

Section: Resultsmentioning

confidence: 99%

“…At the conclusion of screening, 34 articles were included in the present systematic review 4-9,13-40 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…1). Eight studies reported on the biomechanical burden of orthopaedic procedures 13-20 , while 26 studies reported on MSK symptoms or injuries experienced by orthopaedic surgeons 4-9,21-40 .…”

Section: Methodsmentioning

confidence: 99%

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The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons

Covarrubius

Yakkanti

et al. 2023

JBJS Reviews

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Background:Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal (MSK) injuries and chronic pain due to repetitive large magnitude forces, altered posture from lead vests, and prolonged irregular body positions. We sought to synthesize available evidence regarding (1) the biomechanics of orthopaedic surgery and (2) MSK injuries sustained by orthopaedic surgeons with subsequent treatment and consequences.Methods:To conduct this systematic review, we queried 4 databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or MSK injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on non-MSK injuries and injuries in patients or nonorthopaedic specialists. The literature search yielded 3,202 publications, 34 of which were included in the final analysis.Results:Eight studies reported on the biomechanics of orthopaedic surgery. Surgeons spent an average 41.6% of operating time slouched. Head and whole spine angles were closest to natural standing position when using a microscope for visualization and with higher surgical field heights. Use of lead aprons resulted in a shifted weight distribution on the forefoot, gain in thoracic kyphosis, and increase in lateral deviation from postural loading. Twenty-six studies reported on MSK symptoms and injuries experienced by orthopaedic surgeons, with an overall prevalence from 44% to 97%. The most common body regions involved were lower back (15.2%-89.5%), hip/thigh (5.0%-86.6%), neck (2.4%-74%), hand/wrist (10.5%-54%), shoulder (7.1%-48.5%), elbow (3.1%-28.3%), knee/lower leg (7.9%-27.4%), and foot/ankle (7%-25.7%). Of surgeons with any reported MSK symptom or injury, 27% to 65.7% required nonoperative treatment, 3.2% to 34.3% surgery, and 4.5% to 31% time off work. Up to 59.3% of surgeons reported that their injuries would negatively influence their ability to perform surgical procedures in the future.Conclusions:The orthopaedic surgeon population experiences a high prevalence of MSK symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…At the conclusion of screening, 34 articles were included in the present systematic review 4-9,13-40 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons

Covarrubius

Yakkanti

et al. 2023

JBJS Reviews

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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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Design of magnetorheological brake for forearm rotation of a wrist prosthesis

Dutra¹,

Ferreira

Rubio

et al. 2022

2022 International Conference on Rehabilitation Robotics (ICORR)

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Wrist at risk? – Considerations derived from a novel experimental setup to assess torques during hip reaming with potential implications on the orthopedic surgeons’ health

Cited by 3 publications

References 13 publications

The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons

The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons

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

Design of magnetorheological brake for forearm rotation of a wrist prosthesis

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