Haffar Amer, Khan Irfan A, Ong Christian, Magnuson Justin A, Austin Matthew S, Krueger Chad A, Lonner Jess H
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2022 Jun;37(6):1054-1058. doi: 10.1016/j.arth.2022.02.073. Epub 2022 Feb 24.
Orthopedic surgeons experience significant musculoskeletal pain and work-related injuries while performing total joint arthroplasty (TJA). We sought to investigate the impact of operative extremity and surgeon limb dominance on surgeon physiologic stress and energy expenditure during TJA.
This was a prospective cohort study conducted at a tertiary academic practice. Cardiorespiratory data was recorded continuously in 3 high-volume arthroplasty surgeons using a smart garment that measured heart rate (HR), HR variability, respiratory rate, minute ventilation, and energy expenditure (calories) during conventional total knee (TKA) and total hip arthroplasty (THA).
Surgeon 1 and 2 (right-handed) performed 21 right TKAs, 10 left TKAs, 13 right THAs, and 10 left THAs. Surgeon 3 (left-handed) performed 6 right TKAs, 9 left TKAs, 16 right THAs, and 10 left THAs. While performing TKA or THA, limb laterality had no significant impact on operative time and no significant differences existed in HR, HR variability, respiratory rate, minute ventilation, or energy expenditure for any right-handed or left-handed surgeons, regardless of the operative limb laterality. While performing TKA, consistently standing on the side of hand dominance was associated with decreased strain and stress, compared to always standing on the operative side.
This study suggests that surgeon hand dominance and operative limb laterality do not impact energy expenditure or physiologic strain during TJA. However, consistently standing on the side of hand dominance in TKA may lead to decreased physiologic strain and stress during surgery. Further study utilizing wearable technology during TJA may provide orthopedic surgeons with information about modifiable factors that contribute to differences in physiological parameters during surgery.
骨科医生在进行全关节置换术（TJA）时会经历明显的肌肉骨骼疼痛和与工作相关的损伤。我们试图研究手术肢体和外科医生肢体优势对TJA期间外科医生生理应激和能量消耗的影响。
这是一项在三级学术机构进行的前瞻性队列研究。使用智能服装连续记录3名高手术量关节置换外科医生的心肺数据，该智能服装在传统全膝关节置换术（TKA）和全髋关节置换术（THA）期间测量心率（HR）、心率变异性、呼吸频率、分钟通气量和能量消耗（卡路里）。
外科医生1和2（右利手）进行了21例右侧TKA、10例左侧TKA、13例右侧THA和10例左侧THA。外科医生3（左利手）进行了6例右侧TKA、9例左侧TKA、16例右侧THA和10例左侧THA。在进行TKA或THA时，肢体侧别对手术时间没有显著影响，任何右利手或左利手外科医生的HR、心率变异性、呼吸频率、分钟通气量或能量消耗均无显著差异，无论手术肢体侧别如何。在进行TKA时，与始终站在手术侧相比，始终站在优势手一侧与应变和压力降低相关。
本研究表明，外科医生的手优势和手术肢体侧别不会影响TJA期间的能量消耗或生理应变。然而，在TKA中始终站在优势手一侧可能会导致手术期间生理应变和压力降低。在TJA期间利用可穿戴技术进行进一步研究可能会为骨科医生提供有关导致手术期间生理参数差异的可改变因素的信息。
