Occupational hazards in hip and knee adult reconstruction surgery : a systematic review of physical and psychological stressors.

AIMS: Adult reconstruction surgeons face unique occupational challenges during joint arthroplasty procedures, including sustained physical demands, ergonomic strain, noise exposure, and psychological pressure from high patient expectations. This systematic review aimed to synthesize existing evidence regarding physical and psychological stressors encountered by surgeons performing hip and knee arthroplasty. METHODS: Following PRISMA guidelines, we searched PubMed, EMBASE, Web of Science, and Cochrane Library through to December 2024. Studies evaluating occupational hazards during adult hip and knee arthroplasty were included, focusing on noise exposure, ergonomic challenges, musculoskeletal strain, and robotic-assisted platforms' impact on surgeon performance. Risk of bias was assessed using Appraisal tool for Cross-Sectional Studies (AXIS) and Methodological Index for Non-Randomized Studies (MINORS) tools. RESULTS: In total, 38 studies were included, revealing five key hazard categories. Work-related injury prevalence ranged from 66% to 96.5%, predominantly affecting spine (28% to 34.2%), shoulders, and upper limbs. Risk factors included age > 55 years, high surgical volume (> 100 procedures annually), and > 20 years' practice. CO2 accumulation in helmet systems exceeded safety limits in 10/11 configurations tested. Joint arthroplasties generated the highest noise levels (77 dBA to 88.2 dBA) among orthopaedic procedures, with arthroplasty surgeons showing nearly triple the hearing loss rate compared with non-surgical clinicians (31% vs 11%, odds ratio 3.63). Total hip arthroplasty demonstrated higher physiological demands than total knee arthroplasty (heart rate: 95.7 vs 90.2 bpm; energy: 290.2 vs 189.4 kcal). Revision surgeries imposed doubled mental demand scores compared with primary procedures. Robotic assistance improved ergonomics through reduced neck and lumbar flexion, but increased operating times and generated higher noise levels. CONCLUSION: Arthroplasty surgeons face substantial occupational hazards with high musculoskeletal injury rates, significant noise-induced hearing loss, and considerable physiological demands. While emerging technologies show promise in reducing some physical demands, they introduce new ergonomic considerations, highlighting the need for comprehensive occupational health strategies to ensure sustainable surgical careers.