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   Abstract
  Introduction
  Methods
  Results
  Discussion
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ARTICLE  
Year : 2014  |  Volume : 16  |  Issue : 71  |  Page : 205-207
Noise measurement in total knee arthroplasty

1 Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
2 Department of Safety Engineering, Medical University of Graz, Graz, Austria

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Date of Web Publication18-Jul-2014
 
  Abstract 

Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR). The highest levels of noise that have been described were due to instruments used for total knee arthroplasty (TKA). These high levels of noise might be a potential health hazard for patients and medical staff. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide. During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. In total surgical instruments were used for about 10% of the total time of surgery. Noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

Keywords: Noise measurement, surgical instruments, total knee arthroplasty

How to cite this article:
Holzer LA, Leithner A, Kazianschütz M, Gruber G. Noise measurement in total knee arthroplasty. Noise Health 2014;16:205-7

How to cite this URL:
Holzer LA, Leithner A, Kazianschütz M, Gruber G. Noise measurement in total knee arthroplasty. Noise Health [serial online] 2014 [cited 2019 Jan 21];16:205-7. Available from: http://www.noiseandhealth.org/text.asp?2014/16/71/205/137040

  Introduction Top


Total knee arthroplasty (TKA) is an orthopedic surgical technique that aims to restore function in primary or secondary diseased knee joints. TKA is one of the most common orthopedic procedures with about 380 procedures performed in the USA and projections of a further increase. [1],[2] Over the last decades, many advancements have been made in implant design and surgical technique. However, for the implantation of a knee joint prosthesis various surgical instruments are still needed among them are hammers, chisel, drills, and saws. The use of these surgical instruments produces high levels of noise.

Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR). [3],[4] The highest levels of noise that have been described were due to instruments used for TKA. The highest noise levels have been found to exceed 110 dBA. [5],[6],[7] These high levels of noise might be a potential health hazard for patients and medical staff [4],[6] . Data suggests that continuous high noise exposure of levels above 90 dBA might cause hypertension, or hearing loss. [8]

As indicated above advancement in this field is in progress continuously and a variety of different surgical instruments are commercially available. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide.


  Methods Top


Noise measurement

During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter Bruel and Kjaer Type 2240-A (Bruel and Kjaer GmbH, Bremen, Germany). The sound level meter was positioned at level of the head and at a distance of approximately 10 cm away from the surgeon. Noise levels were measured when surgical instruments that are described in detail below were used. The measurements represent the A-weighted equivalent level (Lp,A,T ), expressed in dBA, for the specific interventions. Lp,A,T is the main unit used for assessing occupational noise.

Surgical instruments

The following instruments were used and analyzed during the TKA: Pneumatically-operated tool systems, including oscillating bone saw and air reamer drill II (both Synthes GmbH, Oberdorf, Switzerland) that are commonly used for arthroplasties and large bone surgery, a pneumatically-operated lavage system PALAVAGE ® pulse lavage (Heraeus Medical GmbH, Werheim, Germany), a 700 g hammer and a chisel (both Synthes GmbH, Oberdorf, Switzerland).

Ethics review

According to the policy activities that constitute research at the Medical University of Graz, this work met criteria for operational improvement activities exempt from ethics review.


  Results Top


The results of the noise measurement can be seen in [Table 1]. The A-weighted equivalent level in the OR without the use of any instruments was 70.1 dBA. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. The lowest A-weighted equivalent level was produced, while using a drill with 74.6 dBA. In total, the above described surgical were used for 5 min 47 s, about 10% of the total time of surgery.
Table 1: Duration of instrument use and A-weighted equivalent level of analyzed instruments

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  Discussion Top


We analyzed the noise levels produced by surgical instruments during a conventional primary TKA. Few studies were performed that analyzed the noise levels produced by various surgical instruments. The highest noise levels were found during orthopedic procedures such as TKA exceeding 110 dBA. [5],[6],[7] In this study, the highest A-weighted equivalent levels were found during the use of a hammer with 90.2 dBA. Sydney et al. measured sound levels produced by different pneumatically-operated saws. Noise levels of saws varied significantly and ranged from 81.6 to 88.9 dBA. [9] In this study, the use of a saw reached an A-weighted equivalent level of 88.0 dBA. The total time of instrument use was a <6 min. Considering the recommendations of the WHO regarding occupational noise exposure instrument use during TKA does not seem to be a potential health hazard for medical staff. [8]

Impulse noise is often defined as noise consisting of single bursts resulting from hammering, stamping, pressing, or gunfire with duration of <1 s with peak levels 15 dB higher than background noise. Impulse noise causes more severe hearing loss than steady state noise. Impulse noise differs from steady state noise by the properties in the time domain. The exposure to impulsive noise is often composed of very rapid sound bursts that have short duration and low energy content. As a consequence, the audibility is lower than the actual level of the impulses. The equal energy principle provides a good approximation for the vulnerability of hearing in steady state noise. However, the time domain characteristics of noise have been shown to affect the harmfulness of noise. The risk of noise-induced hearing loss is higher in the occupations where workers are exposed to impulse noise. In several occupations, the impulses are so rapid that they contribute only a minimal amount to the energy content of noise. [10]

The background noise level in the OR was high with an A-weighted equivalent level of 70.1 dBA. This level is above the level that is recommended by various European authorities (a maximum 1 h equivalent level of 55 dBA for work that requires a high level of concentration) and the WHO (as low as possible) for hospital operation rooms. [8],[11] Communication between surgeons and medical staff during surgery is fundamentally essential for a good surgical result. [12] High background noise levels during TKA might interfere with communication. From this point of view, the introduction of measures to reduce noise levels would be indicated.


  Conclusion Top


Occupational noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

 
  References Top

1.Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87:1487-97.  Back to cited text no. 1
    
2.Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 2013;95:385-92.  Back to cited text no. 2
    
3.Kracht JM, Busch-Vishniac IJ, West JE. Noise in the operating rooms of Johns Hopkins Hospital. J Acoust Soc Am 2007;121:2673-80.  Back to cited text no. 3
    
4.Fritsch MH, Chacko CE, Patterson EB. Operating room sound level hazards for patients and physicians. Otol Neurotol 2010;31:715-21.  Back to cited text no. 4
    
5.Love H. Noise exposure in the orthopaedic operating theatre: A significant health hazard. ANZ J Surg 2003;73:836-8.  Back to cited text no. 5
[PUBMED]    
6.Nott MR, West PD. Orthopaedic theatre noise: a potential hazard to patients. Anaesthesia 2003;58:784-7.  Back to cited text no. 6
    
7.Fitzgerald G, O'Donnell B. "In somno securitas" anaesthetists' noise exposure in Orthopaedic operating theatres. Ir Med J 2012;105:239-41.  Back to cited text no. 7
    
8.Concha-Barrientos M, Campbell-Lendrum D, Steenland K. Occupational Noise: Assessing the Burden of Disease from Work-Related Hearing Impairment at National and Local Levels. (WHO Environmental Burden of Disease Series, No. 9). Geneva: World Health Organization; 2004.  Back to cited text no. 8
    
9.Sydney SE, Lepp AJ, Whitehouse SL, Crawford RW. Noise exposure due to orthopedic saws in simulated total knee arthroplasty surgery. J Arthroplasty 2007;22:1193-7.  Back to cited text no. 9
    
10.Starck J, Toppila E, Pyykkö I. Impulse noise and risk criteria. Noise Health 2003;5:63-73.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.Suter AH. Noise. In: Stellman JM, editor. Encyclopedia of Occupational Health and Safety. Geneva: International Labor Organization; 1998. p. 47.  Back to cited text no. 11
    
12.Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: An observational classification of recurrent types and effects. Qual Saf Health Care 2004;13:330-4.  Back to cited text no. 12
    

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Correspondence Address:
Dr. Lukas A Holzer
Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz
Austria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1463-1741.137040

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    Tables

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