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Use of an Automated Impactor for Total Hip Arthroplasty Does Not Increase Surgeon Noise Exposure Over Manual
Aaron M Davidson1, Jonathan Brutti1, Zachary Grand1
1Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
Background:
Total hip arthroplasty (THA) is associated with high intraoperative noise exposure, raising concerns for occupational hearing risk. Automated impaction systems are increasingly used, but their effect on sound levels compared to traditional manual techniques remains unclear. This study evaluated intraoperative sound exposure during THA using automated vs manual impaction.
Methods:
In this observational study, intraoperative sound measurements were collected during primary THA via a direct anterior approach at a single institution. A calibrated external microphone positioned near the surgeon's hearing zone recorded sound during a standardized 180-second impaction interval. Primary outcomes included peak sound level (LApeak, dB), average continuous sound level (LAeq, dB), and total sound exposure (dB-seconds). Cases were grouped by impaction method (automated vs manual). Independent t-tests compared sound metrics, and Pearson correlation assessed associations with implant size.
Results:
Twenty cases were analyzed (10 automated, 10 manual). No significant differences were observed between automated and manual impaction for LApeak (95.22 vs 95.24 dB, P = .975), LAeq (84.36 vs 84.23 dB, P = .888), or total sound exposure (15,130.5 vs 15,097.4 dB-seconds, P = .848). Implant size and laterality were not associated with sound measurements. Strong correlations were observed between LAeq and total sound exposure (r = 0.981, P < .001).
Conclusions:
Automated impaction did not significantly alter intraoperative sound exposure compared to manual techniques. Noise levels were consistent across procedural variables, suggesting that acoustic burden is inherent to THA. Procedure-level strategies may help mitigate occupational noise exposure.
