Intraoperative Surgical Smoke During Arthroplasty: Early Unhealthy-Level Exposure and Approach-Dependent Risk.

Area of Science:

• Orthopedic Surgery
• Environmental Health
• Occupational Safety

Background:

• Surgical smoke is a byproduct of electrocautery, containing toxic compounds and fine particulate matter (PM2.5).
• Intraoperative exposure to surgical smoke during joint arthroplasty is not well understood.
• Quantifying PM2.5 exposure is crucial for assessing risks to operating room personnel.

Purpose of the Study:

• To quantify intraoperative fine particulate matter (PM2.5) exposure during various joint arthroplasty procedures.
• To determine if PM2.5 levels during arthroplasty reach potentially harmful concentrations.
• To compare PM2.5 exposure across different arthroplasty procedures and surgical approaches.

Main Methods:

• Prospective study of 83 primary arthroplasties: bipolar hemiarthroplasties (BHAs), total hip arthroplasties (THAs), and total knee arthroplasties (TKAs).
• Real-time measurement of intraoperative PM2.5 concentrations using portable monitors.
• Mapping PM2.5 levels to Air Quality Index (AQI) categories and calculating exposure metrics.

Main Results:

• Bipolar hemiarthroplasty (BHA) and total knee arthroplasty (TKA) showed significantly higher PM2.5 concentrations than total hip arthroplasty (THA).
• Median maximum PM2.5 levels were substantially elevated in BHA (129.50 µg/m³) and TKA (118.80 µg/m³) compared to THA (6.14 µg/m³).
• A high percentage of BHA (80%) and TKA (71%) cases reached an "Unhealthy" AQI, while THA cases mostly remained in "Good" or "Moderate" categories.

Conclusions:

• Direct lateral approach BHA and TKA generate significantly higher intraoperative PM2.5 than direct anterior approach THA.
• Many arthroplasty procedures result in PM2.5 exposure levels considered unhealthy.
• Comprehensive control strategies, including smoke evacuation and respiratory protection, are essential in arthroplasty settings.