How noisy are total knee and hip replacement surgeries?

Noise-Induced Hearing Loss (NIHL)  in the workplace is called occupational hearing loss. Exposure develops slowly over the years and varies according to sensitivity.

According to a study conducted by the US National Institutes of Health in 1990, 1/3 of all hearing loss is due to noise. 1 In addition, noise-induced hearing loss (NIHL) is the most common occupational disease in the United States. 2 Since it naturally increases with age, the probability of hearing loss in people who are not exposed to noise at the age of 35 and 65 is estimated to be 10% and 55%, respectively. A ten-year exposure to noise at 100 dB increases the probability of hearing impairment in the same individuals to 94.5% and 99.5%. 3

Why Are Orthopedic (Arthroplasty – Total Knee and Hip Replacement Surgeries) Surgeries Noisy?

We can compare the hand tools and surgical power tools used in arthroplasty surgeries to the equipment used in a carpenter’s shop.  The process is technically the same: The process of shaping a material (wood in the carpenter’s shop, bone in orthopedics).

Orthopedic surgeons work in an environment that can increase the risk of NIHL. 4 50% of the personnel working in orthopedic operating rooms have NIHL characteristics. 5, 6 Surgeons who perform operations with surgical power tools and hand tools may be more affected because they are very close to the sounds.

What are the Effects of Noise on Humans?

The known negative effects of noise are as follows;

Physical : Temporary or permanent hearing impairment

Physiological : Increased blood pressure, circulatory impairment, accelerated respiration, slowing of heart rate

Psychological : Behavioral impairments, extreme irritability and stress

Effects on Performance: Decreased work efficiency, impaired concentration, slowing of movements

Murthy et al. reported in 1995 that 77 dB or more of background noise leads to a decrease in brain cognitive function and efficiency, a decrease in short-term memory, and a decrease in the ability to identify speech components. 7, 8 The recommended decibel threshold is 55 dB for surgical operations and jobs that require quick decision making, under pressure, and with serious consequences. 9

Orthopedic surgeries (especially total knee replacement surgeries and total hip replacement surgeries) are surgeries with a very high sound level. Noise is generated by surgical power tools (Saw, Drill, Reamer) and hammer-like hand tools that make noise with impact. Impact noise is more harmful than constant levels and causes more hearing loss. 10

According to European Union (EU) Directive 2003/10/EC, hearing protection must be provided at an equivalent continuous sound pressure level (Leq) of 80dB for an average eight-hour working day. 11

Are There Any Studies on Noise Levels in Orthopedics (Arthroplasty – Total Knee and Hip Replacement Surgeries) Surgeries?

JP Simpson and AJ Hamer conducted a study in 2017 about how noisy orthopedic surgeries are. They found that in total knee arthroplasty performed within the scope of this study, the loudest sound occurred during hammering (105.6 dB). The oscillating saw power tools (97.9 dB) and pneumatic rasping power tools (95.7 dB) were also found to produce critical levels of noise. Noise levels exceeded 90 dB in each operation. 12 It is thought that the sound values obtained in the study may be lower than the sounds in the ear of the surgeon.  Because sound-receiving microphones could be placed at distances allowed by the operational area. (Approximately 1.5m)

It has been studied many times that noise levels in orthopedic surgeries are greater than 110 dB. 13, 14, 15 It has also been observed that these surgeries consistently produce peak sound pressure levels that reach above 100 dB with peak values exceeding 120 dB. 16


Like any surgery, orthopedic surgeries are surgeries where the surgeon is under pressure and makes critical decisions. The effect of noise on the decision-making mechanism is known.

Studies show that arthroplasty surgeries generate noise above critical levels. Even if these sounds do not create constant decibel noises (hammer blow, surgical power tools such as saw, drills, reamers, etc.), they have high sound levels that rise abruptly. These increases do not immediately harm the surgeons’ ear health. However, considering a working life of 30-40 years, these accumulated negative effects can cause NIHL.

Surgeons need to be in contact with technicians and nurses during surgery. For this reason, it is not possible to wear earplugs during the entire surgery. However, the surgeon must be protected while performing these loud noise-producing procedures.

Headphones, which have emerged in recent years with the development of technology and instantly eliminate ambient noise, can be used in these surgeries after further research.

Noise in orthopedic surgeries is a potential occupational hazard that needs to be considered by staff and further investigation.

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  1. National Institutes of Health. Consensus Development Conference Statement: Noise and Hearing Loss. Bethesda, MD; U.S. Department of Health &Human Services; 1990.
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  11. European Union 2003 Directive 2003/10/EC of the European Parliament and of the Council of 6 February 2003 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (noise) Article 16(1) of Directive 89/391/EEC Official Journal of the European Union Brussels
  12. JP Simpson and AJ Hamer. 2017. How noisy are total knee and hip replacements?. The Association for Perioperative Practice. Volume 27 – Issue 12 – ISSN 1750 – 4589295.
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