The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Surgeons: A Systematic Review

Abstract

Category: Other; Trauma Introduction/Purpose: Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal injuries and chronic pain. This is largely due to daily exposure to repetitive large magnitude forces, altered posture from the use of leaded vests, and prolonged standing often in irregular body positions. We sought to synthesize available evidence regarding 1) the biomechanics of orthopaedic surgery and 2) musculoskeletal injuries sustained by orthopaedic surgeons with subsequent treatment and consequences. Methods: To conduct this systematic review, we queried four databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or musculoskeletal injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on injuries to patients, non-musculoskeletal injuries, or non-orthopaedic subspecialties. The literature search yielded 3,202 publications, 36 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 time slouched during surgeries. 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-eight studies reported on musculoskeletal conditions experienced by orthopaedic surgeons. The overall prevalence of musculoskeletal symptoms or injury involving any body region ranged from 44-97%. Prevalence by body region in decreasing order were as follows: lower back (15.2-89.5%), hip/thigh (4.4- 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 musculoskeletal symptom or injury, 27-65.7% required nonoperative treatment, 3.2- 34.3% required surgery, and 33.3-59.3% indicated that their operative performance was affected. Conclusion: The orthopaedic surgeon population experiences a high prevalence of musculoskeletal symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations. Ergonomic interventions must be taken within the operating room to reduce this prevalence, increase the physical well-being of orthopaedic surgeons, and reduce the healthcare costs associated with time off work and early retirement as a result of musculoskeletal conditions.