‘Ergopaedics’: the future of ergonomics in orthopaedics
Ergonomics is the scientific study of people and their working conditions, aiming to improve effectiveness. Improved ergonomics of orthopaedic theatres and equipment would reduce the risk of occupational injury and help to encourage more women into an underrepresented specialty.
Author details can be found at the end of this article Correspondence to: Gregory Neal-Smith; gregnealsmith@doctors. org.uk
How to cite this article: Neal-Smith G, Butler K, Patel B, Huntley D, Wood A. ‘Ergopaedics’: the future of ergonomics in orthopaedics. Br J Hosp Med. 2021. https://doi.org/10.12968/ hmed.2021.0581
ntroduction Ergonomics is the study of people’s efficiency in their working environment. It is more relevant now than ever in trauma and orthopaedic surgery, as it impacts on a number of issues, including a high rate of occupational injuries, perceived barriers of entry for women and the incorporation of novel technologies.
Ergonomics focuses on how the working environment is designed to suit the worker. This includes the design of instruments, machines, systems and environments for safe, comfortable and effective use (Schlussel and Maykel, 2019).
Surgeons face hazardous working conditions as a result of ergonomic deficiencies in operating theatres (Schlussel and Maykel, 2019). Yet there is limited research on ergonomics, particularly in trauma and orthopaedics. The future of orthopaedics is inextricably linked to ergonomics. Without acknowledging this vital link, there is the risk of jeopardising the safety of surgeons, stifling innovation and failing to encourage new staff, particularly women, into the specialty – all resulting in worse patient outcomes. Reducing musculoskeletal injury Trauma and orthopaedic surgery involves a high demand on the musculoskeletal system of surgeons. Body positions adopted while operating can contribute to injury (AlQahtani et al, 2016). A study conducted with the Orthopaedic Trauma Association showed that two-thirds of orthopaedic surgeons reported at least one musculoskeletal injury during their career, with the most common injuries being lower back pain (27%) and forearm tendonitis (17%) (AlQahtani et al, 2016). Patient care can be affected, as 36% of injured surgeons reported that their performance in theatre was impacted (Davis et al, 2013), and 27% of orthopaedic trauma surgeons reported that they required time off work as a result of injury (AlQahtani et al, 2016). This can result in financial and psychological consequences, with permanent effects on their career (Davis et al, 2013).
Another issue is protection for orthopaedic surgeons using powered tools and loud instruments. Willett (1991) showed that noise-induced hearing loss can result from years of exposure to orthopaedic instruments. The suggestion of using routine hearing protection has been met with resistance because of the cumbersome nature of the equipment and the risks of impeding communication (Butt et al, 2014). Perhaps the solution could be found within the military? In 2015, the UK Ministry of Defence introduced a tactical hearing protection system featuring lightweight, in-ear protection headsets. These allow situational awareness, comfort and protection against impulse noises and hearing loss (Sumsion, 2017). The orthopaedic community should investigate whether this could be adapted to solve similar problems.
Furthermore, there is limited support for surgeons to help with their recovery from occupational injury. Davis et al (2013) found that only 38% of orthopaedic surgeons who sustained musculoskeletal injuries had institutional support following their injury. The exponentially growing demand for orthopaedic surgeons, retirement age and output will have a crucial impact on the delivery of orthopaedic care. Therefore, the work efficiency and physical health of orthopaedic surgeons needs to become a priority.
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British Journal of Hospital Medicine | November–December 2021 | https://doi.org/10.12968/hmed.2021.0581