Surgeons Experience More Physiologic Stress and Strain During Revision Than Primary Total Joint Arthroplasty

Abstract

Background: Revision total knee arthroplasty (rTKA) and total hip arthroplasty (rTHA) procedures are more complex than primary TKA and THA, but their physiologic burden to the surgeon has not been quantified. While rTKA and rTHA have longer operative times, it is unknown whether differences exist in stress and strain compared to primary TKA and primary THA. The study was conducted to elicit whether differences exist in surgeon physiological response while performing rTKA and rTKA compared to primary TKA and primary THA.

Methods: We evaluated a prospective cohort study of 70 consecutive cases (23 primary TKAs, 12 primary THAs, 16 rTKAs, and 19 rTHAs). Two high-volume fellowship-trained arthroplasty surgeons wore a smart vest that recorded cardiorespiratory data while performing primary THA, primary TKA, rTHA, and rTKA. Heart rate (beats/minute), stress index (correlates with sympathetic activation), respiratory rate (respirations/minute), minute ventilation (L/min), and energy expenditure (Calories) were collected for every case, along with patient body mass index (kilograms/meter²) and working operative time (minutes). T-tests were used to assess for differences between the two groups.

Results: Compared to primary TKA, performing rTKAs had a significantly higher surgeon stress index (17 versus 15; P = .035), heart rate (104 versus 99; P = .007), energy expenditure per case (409 versus 297; P = .002), and a significantly lower heart rate variability (11 versus 12; P = .006). Compared to primary THA, performing rTHA had a significantly higher energy expenditure per case (431 versus 307; P = .007) and trended towards having a higher surgeon stress index (16 versus 14; P = .272) and a lower heart rate variability (11 versus 12; P = .185), although it did not reach statistical significance.

Conclusion: Surgeons experience higher physiological stress and strain when performing rTKA and rTHA compared to primary TKA and primary THA. This study provides objective data on what many surgeons feel and should promote further research on the specific stress and strain felt by surgeons who perform revision arthroplasty procedures.

Keywords: energy expenditure; primary TJA; revision TJA; smart vest; strain; stress.