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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_10 | Pages 20 - 20
1 Aug 2021
Palmer J Fraig H Wilson C Garrett S
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Noise induced hearing loss (NIHL) is a common cause of preventable deafness in adults and exposure to loud noise at work is a significant risk factor for its development. In order to protect the hearing of workers in the U.K., the Health and Safety Executive (HSE), on behalf of the Department for Work and Pensions, established the Control of Noise at Work Regulations (2005). The objectives of this study were to define the levels of noise exposure for the surgeon, assistant, scrub nurse and anaesthetist during total hip and knee arthroplasty surgery. In addition, we sought to determine whether the noise exposure during these procedures reaches or exceeds the action values set out by the U.K. Noise at Work Regulations (2005). To our knowledge no real-time assessment of personal noise exposure has been performed simultaneously on multiple members of the theatre team during arthroplasty surgery.

Individual noise exposure during arthroplasty hip and knee surgery was recorded using a personal noise dosemeter system model 22 (DM22) (Pulsar instruments, Filey, U.K.). Recordings were taken real-time during five separate theatre sessions. Each theatre session included two arthroplasty procedures and lasted approximately 4hrs. Personal noise exposure was expressed in terms of peak sound pressure and an average noise exposure over an 8-hour time-period to reflect the noise experienced by the ear over a working day.

In all three sessions involving total hip replacement surgery the peak sound pressure, for the operating surgeon, exceeded the exposure action values set out by the U.K. Noise at Work Regulations. Theatre sessions involving total knee replacement surgery did not exceed any exposure action values.

The peak sound pressures experienced during total hip replacement surgery are too high and mandate that the surgeon should be provided with appropriate hearing protection. In addition, if the upper exposure action value is routinely exceeded then the theatre should be designated a hearing protection zone.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 137 - 137
1 May 2016
Abouel-Enin S Fraig H Griffiths J Latham J
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Introduction

Trial reduction while performing total hip replacement is an essential step of the procedure. This is to check the stability of the hip joint with the selected implant sizes and to assess the leg length to avoid discrepancy.

Disengagement of the femoral head trial from the femoral rasp stem, with subsequent migration of the trial head into the pelvic cavity is a rare occurrence, but can be a very frustrating complication to both the surgeon and occasionally the patient.

We present our experience with this exceptional situation and different management options, together with systematic review of the literature.

Patients and methods

We conducted Medline database search via Pubmed interface. MeSH search was used. Systematic review of English literature case reports was performed.

15 reports were found discussing intra-pelvic migration of different arthroplsty related materials.

The total number of reported cases was 24 cases, out of those, 21 cases were related to migration of femoral trial head, 2 cases of migrated modular hemiarthroplasty bipolar heads and one case of migrated femoral head definitive implant.