Jeffrey Henstenburg - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
Walaa Abdelfadeel - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
Anthony Boniello - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
Joseph Schmitz - Drexel University College of Medicine, Philadelphia, PA, USA
Jeffrey Vakil - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
Andrew Star - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA

Background: Orthopaedic surgeons rely on visual and tactile cues to guide performance in the operatingroom (OR). However, there is very little data on how sound changes during orthopaedic procedures andhow surgeons incorporate audio feedback to guide performance. This study attempts to define meaningfulchanges in sound during vital aspects of total hip arthroplasty (THA) within the spectrum of human hearing.Methods: ۸۴ audio recordings were obtained during primary elective THA procedures during sawing of thefemoral neck, reaming of the acetabulum, acetabular cup impaction, polyethylene liner impaction, femoralbroaching, planning of the femoral calcar and press-fit of a porous-coated stem in ۱۴ patients. We graphedchanges in frequency intensity across the human spectrum of hearing and sampled frequencies showingdifferences over time for statistically meaningful changes.Results: Sawing of the femoral neck, polyethylene impaction, and stem insertion showed significanttemporal increases in overall sound intensity. Calcar planing showed a significant decrease in soundintensity. Moreover, spectrographic analysis showed that, for each of the critical tasks in THA, there werecharacteristic frequencies that showed maximal changes in loudness. These changes were above the ۱ dBchange in intensity required for detection by the human ear.Conclusion: Our results clearly demonstrate reproducible sound changes during total hip arthroplasty thatare detectable by the human ear. Surgeons can incorporate sound as a valuable source of feedback whileperforming total hip arthroplasty to guide optimal performance in the OR. These findings can be extrapolatedto other orthopaedic procedures that produce characteristic changes in sound. Moreover, it emphasizes theimportance of limiting ambient noise in the OR that might make sound changes hard to distinguish.Level of evidence: IV

Acoustics, Arthroplasty, Hip, Performance, Sound