Musculoskeletal pain and surgical ergonomics among orthopedic residents in Saudi Arabia: a cross-sectional study

Poor surgical ergonomics may be associated with an increased risk of musculoskeletal pain (MSP) and injuries among surgeons in the workplace. We aimed to assess the knowledge, attitudes, and practices regarding surgical ergonomics and to determine the prevalence of MSP among orthopedic residents in Saudi Arabia. Methods: This research employed a cross-sectional design using a modified, validated tool distributed among orthopedic surgery residents. We performed tests of association between knowledge, attitude, and practice of surgical ergonomics and demographic and clinical characteristics, as well as their impact on the prevalence of MSP.

Among 158 orthopedic residents, 77.8% were male, with most in their first or second year of training. MSP was reported by 75.9%, predominantly affecting the lower back, feet, and neck. Trauma surgery was the most discomfort-provoking subspecialty (69%). MSP influenced fellowship decisions, mobility, and frustration tolerance. Changing posture during procedures was the most frequently used coping strategy. Greater knowledge of surgical ergonomics was associated with significantly lower odds of reporting moderate-to-severe MSP (odds ratio (OR) = 0.324, 95% CI [0.132-0.794], p = 0.014). A positive attitude toward surgical ergonomics was similarly associated with significantly lower odds of experiencing moderate-to-severe MSP (OR = 0.304, 95% confidence interval (CI) [0.108-0.855], p = 0.024).

MSP was widespread among orthopedic residents and influenced both performance and career choices. Procedure-related pain impaired mobility and operative efficiency, while most residents relied on personal coping strategies in the absence of structured ergonomic support. Greater ergonomic knowledge and more positive attitudes were associated with lower odds of moderate-to-severe MSP, whereas reported practices showed no clear association. Despite broad support for formal ergonomics training, institutional provision remains limited. These cross-sectional study findings reflect associations rather than causality, underscoring the need for longitudinal research to better understand how ergonomic education and practice influence MSP over time.