Noise Exposure and Risk of Noise Induced Hearing Loss to the Adult Reconstruction Surgeon: Recommendations for Prevention and Monitoring.

Goal of the study was to determine the average noise exposure to the orthopaedic surgeon performing hip and knee arthroplasty and the benefit of customized hearing protection. Data from dosimeters (3MTM Edge 4) worn by three adult reconstruction orthopedic surgeons for a total of 27 operative day recordings was analyzed using 3MTM Detection Management Software (product version 2.7.152.0). Westone TRU custom hearing protection was used with different filters according to noise reduction rating (NRR). The overall average decibel level was 80.64 dB (73.6-87.2 dB, +/- 4.18). The peak decibel level averaged 103.66 dB (97.30-110.30, +/-3.02). The authors subjective trial of custom hearing protection determined the NRR 10 and 15 filters were most effective at noise reduction with adequate ability to communicate effectively. Our study demonstrates that the daily exposure to the total joint surgeon exceeds safe levels. (Journal of Surgical Orthopaedic Advances 29(4):202-204, 2020).

Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders.

With a growing prevalence for chronic renal failure, arthroplasty surgeons will find it more likely to have dialysis dependent patients present for knee replacement. Previous retrospective studies using a matched cohort of patients have reported worse perioperative outcomes for dialysis-dependent patients. However, many of these studies failed to control for pertinent confounders. This study aims to fill in that void. The present study compares lengths of stay, discharge status, and 30-day outcomes between dialysis-dependent TKA recipients and a matched cohort of nondialysis dependent TKA recipients. The National Surgical Quality Improvement Program database was used to identify the study cohorts. Patients were propensity score matched based on patient-specific demographic variables, preoperative functional status, and preoperative laboratory values. Generalized regression models were conducted to assess the effects of dialysis dependency on perioperative outcomes. Dialysis dependent patients demonstrated longer mean lengths of stay (+1.14) and a lower likelihood for home discharge (odds ratio [OR] = 0.503). There was no increased risk of 30-day complications in dialysis dependent TKA patients. Our findings demonstrate no increased risk of 30-day complications after TKA when adjusting for pertinent confounders. This suggests TKA is safe for well optimized dialysis dependent patients prior to surgery.

Quantifying the force transmission through the pelvic joints during total hip arthroplasty: A pilot cadaveric study.

BACKGROUND: Total hip arthroplasty is one of the most successful and cost effective procedures in orthopedics. The purpose of this study is to investigate force transmission through the sacroiliac joint as a possible source of post-operative pain after total hip arthroplasty through the following three questions: Does the ipsilateral sacroiliac joint, contralateral sacroiliac joint, or pubic symphysis experience more force during placement? Does the larger mallet used to seat the implant generate a higher force? Does the specimen's bone density or BMI alter force transmission? METHODS: A solid design acetabular component was impacted into five human cadaver pelves with intact soft tissues. The pressure at both sacroiliac joints and the pubic symphysis was measured during cup placement. This same procedure was replicated using an existing pelvis finite element model to use for comparison. FINDINGS: The location of the peak force for each hammer strike was found to be specimen specific. The finite model results indicated the ipsilateral sacroiliac joint had the highest pressure and strain followed by the pubic symphysis over the course of the full simulation. The heft of the mallet and bone mineral density did not predict force values or locations. The largest median force was generated in extremely obese specimens. INTERPRETATION: Contrary to previous ideas, it is highly unlikely that forces experienced at the pelvic joints are large enough to contribute post-operative pain during impaction of an acetabular component. These results indicate more force is conveyed to the pubic symphysis compared to the sacroiliac joints.