The assessment of muscle fatigue in orthopedic surgeons, by comparing manual versus automated broaching in simulated total hip arthroplasty

Total hip arthroplasty procedures are physically demanding for surgeons. Repetitive mallet swings to impact a surgical handle (impactions), can lead to muscle fatigue, discomfort, and injuries. The use of an automated surgical hammer may reduce fatigue and increase surgical efficiency. The aim of this study was to compare the effect of repeated manual and automated impactions on the user's muscle activation, by means of surface electromyography. Surface electromyography signals were recorded from eight muscles of seven (n = 7) orthopedic surgeons during repetitions of manual and automated impactions, to reach the same surgical outcome (broaching depth). Qualitative data was also captured to track the perceived fatigue and preferences of impaction modalities after completion of impaction tasks. Time to complete tasks, muscle activation, and muscle fatigue were quantified. Results showed a significant decrease in time required to reach the same broaching depth for the automated method compared to manual impactions (p = 0.001). A reduction in muscle fatigue and activation of right Brachioradialis muscle was observed during automated impactions (p = 0.018). A significant difference in fatigue was observed, with lower level of fatigue during automated impactions (p = 0.001). These results suggest that an automated surgical workflow might reduce the exposure to the impaction task and, therefore, muscle fatigue, with a reduced activation of the most engaged muscles. The study suggests that the burden on the user can be reduced by a change in the surgical methodology to perform broaching in total hip arthroplasty, which could potentially benefit surgical efficiency and reduce the risk of fatigue-based errors during a procedure.