Arthroplasty surgeons showed more physiological stress, strain in revision vs. primary TJA
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LAS VEGAS — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed arthroplasty surgeons experienced significantly greater physiological stress and strain when performing revision total joint arthroplasty.
“When scheduling revision and primary total joint arthroplasty, surgeons should consider the higher physiological demand associated with revision total joint arthroplasty and ensure adequate personal preparation,” Irfan A. Khan, ATC, said in his presentation here. “Further study is needed to determine the generalizability of these results and to identify modifiable risk factors for stress and strain during arthroplasty.”
Khan and colleagues collected cardiorespiratory data using a smart vest among two high-volume fellowship-trained arthroplasty surgeons during primary (n=35) and revision (n=35) TJA.
“For the total hip arthroplasties, they were performed using a direct anterior, anterolateral or posterolateral approach, while total knee arthroplasty was done using a medial parapatellar approach,” Khan said.
Researchers collected patient BMI, surgical limb laterality and operative time, along with surgeon heart rate, surgeon stress index and surgeon heart rate variability.
Khan noted revision TJA cases had significantly lower BMI, significantly longer operative time and were more often performed using the posterolateral approach.
“When looking at differences between primary and revision total joint arthroplasty, there was a significantly higher energy expenditure and calories per hour, as well as significantly higher heart rate when performing revision total joint arthroplasty,” Khan said.
He added surgeons experienced a significantly higher rate of stress when performing revision TJA.
In subgroup analysis, revision TKA was associated with a significantly higher energy expenditure, heart rate and stress index, according to Khan. He added revision TKA was linked with a significantly lower heart rate variability, indicating increased stress and strain compared with primary TKA.
“When doing a subgroup analysis for hip cases, there were no significant differences for patient BMI or operative time; however, there was a significantly higher rate of energy expenditure when performing revision total hip arthroplasty and, although it was not significant, there does appear to be a higher stress index as well when performing a revision total hip arthroplasty,” Khan said.
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Krueger CA, et al. Paper 285. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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