Sound levels in the operating theatre resulting from hammering during cementless total hip arthroplasty

Although hearing loss in orthopaedic surgeons from exposure to hammering sounds have been previously reported, there are no reports on the noise environment during total hip arthroplasty (THA) in Japan. The aim of this study was to investigate the sound level generated by cementless THA in Japan, and to discuss the broader sound environment within this space.

94 cementless THAs (94 patients with informed consent) performed by four surgeons were included. The equivalent continuous A-weighted sound levels (LAeq) in a series of 1086 continuous hammering maneuvers without pause and the maximum C-weighted sound levels (LCpeak) in 17,210 hammering sounds were investigated.

Among the hammering sounds analysed in terms of LAeq, the sound pressure level associated with some procedures did result in non-scrubbed personnel being exposed to the 8-h sound levels exceeding the LAeq threshold (85 dB), while most procedures exceeded this threshold for scrubbed personnel. For scrubbed personnel, the maximum number of operations that could be safely attended per day were 16.1 and 1.6 operations under average and worst-case scenario conditions, respectively. For LCpeak, no sound was found to be above the threshold (135 dB) for either non-scrubbed or scrubbed personnel.

Although average sound levels in a standard operating theatre during cementless THA did not exceed recommended thresholds among non-scrubbed medical practitioners, our data are not sufficient to conclude that the sound environment is safe for scrubbed personnel close to the sound source. Further investigation is needed regarding sound exposure and the occurrence of hearing impairment in surgeons who perform total hip arthroplasties.