Noise-Related Injury During Robotic versus Manual Total Knee Arthroplasty

Occupational noise exposure during robotic total knee arthroplasty (TKA) poses a risk to orthopaedic surgeons that has not been quantified in the literature. According to National Institute for Occupational Safety and Health (NIOSH) guidelines, noise exposure levels at or above 85 decibels as an 8-hour time-weighted average (TWA) are hazardous. The objectives of this study were to compare noise metrics between manual and robotic TKAs and determine if the TWA of each group exceeds the NIOSH guidelines required for workplace noise safety.

Intraoperative audio was recorded during manual and two different robotic TKAs. The DecibelX application was used to record the duration of exposure, average and maximum decibel level, TWA, noise dose percentage of maximum allowable daily noise, and noise dose percentage projected forward over eight hours. Dwass-Steel-Critchlow-Fligner and Kruskal-Wallis tests were performed. Statistical significance was set at P < 0.05.

There were 66 recordings analyzed. The mean duration of exposure and mean maximum decibels were comparable between the groups. The mean average decibel level was 92.7 dB for manual TKA, 97.6 dB for robotic TKA system A, and 92.7 dB for robotic TKA system B (P < 0.01). The mean noise dose for manual TKA was 114.1, 235.7 for robotic TKA system A and 83.6% for robotic TKA system B (P < 0.01). The mean projected noise dose for manual TKA was 818.9, 1,936.3 for robotic TKA system A and 667.9% for robotic TKA system B (P < 0.01). The mean TWA was 83.8 dB for manual TKA, 88.3 dB for robotic TKA system A, and 82.8 dB for robotic TKA system B (P < 0.01).

With a mean TWA of 88.3 dB, robotic TKA system A procedure is above the limit of 85 dB set by NIOSH occupational noise exposure guidelines and is in the range of noise levels that are known to cause noise-induced hearing loss.