Operating Table Height Optimization Reduces Surgeon Postural Load During Total Knee Arthroplasty: An Ergonomic Simulation Study

Abstract

Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic working-height recommendations in orthopaedic surgery remains limited. Methods: A simulated left total knee arthroplasty (TKA) was divided into twelve critical surgical steps and analysed across four commonly used surgeon positions (A-D). Two conditions were compared: uncorrected working height (N) and working height corrected according to Canadian Centre for Occupational Health and Safety (CCOHS) recommendations (C). Joint angles were measured from standardized photographs using Kinovea software, and postural load was quantified with the Rapid Entire Body Assessment (REBA) method. Two trained evaluators conducted three independent assessments, yielding 288 REBA scores. Results: Mean REBA scores decreased across all surgeon positions following ergonomic correction, with statistically significant reductions observed in positions A, B, and D. When pooled across all position-step combinations (n = 48), the mean reduction was 0.92 REBA points (95% CI 0.50-1.33; p < 0.001). Notably, 27 of the 48 position-step comparisons exceeded the minimal detectable change threshold. The largest reductions occurred during force-intensive surgical steps, including bone cutting, drilling, and implant impaction. Conclusions: Adjusting working height in accordance with CCOHS ergonomic recommendations reduces surgeons' postural load during TKA. These findings support the integration of evidence-based ergonomic adjustments into routine orthopaedic surgical practice.