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.

'You are just left to get on with it': qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis

OBJECTIVES

Although the transition to secondary progressive multiple sclerosis (SPMS) is known to be a period of uncertainty for clinicians, who may find progressive disease challenging to objectively identify, little research has explored the experiences of patients and carers specifically during this transition period. Our objective was to explore what patients and their carers understand about their disease stage and describe their experiences and perspectives on the transition to SPMS.

DESIGN

Semistructured qualitative interviews and subsequent validation focus groups were analysed using inductive thematic analysis.

SETTING

South East Wales, UK.

PARTICIPANTS

20 patients with MS and 13 carers were interviewed. Eight patients and two carers participated in focus groups.

RESULTS

Four main themes around disease progression were identified. 'Realisation' describes how patients came to understand they had SPMS while 'reaction' describes their response to this realisation. The 'realities' of living with SPMS, including dealing with the healthcare system during this period, were described along with 'future challenges' envisaged by patients and carers.

CONCLUSIONS

Awareness that the transition to SPMS has occurred, and subsequent emotional reactions and coping strategies, varied widely between patients and their carers. The process of diagnosing the transition was often not transparent and some individuals wanted information to help them understand what the transition to SPMS meant for them.