WHY IS LEFT TOTAL KNEE ARTHROPLASTY SURGERY HARDER FOR RIGHT-HANDED ORTHOPEDIC SURGEONS? SIDE ANALYSIS IN TOTAL KNEE ARTHROPLASTY

Abstract

Objective: We hypothesize that right-handed surgeons can achieve equally successful results in both right and left sides of patients, although they are exposed to more occupational damage when performing knee arthroplasty on the left side.

Material and Methods: A total of 246 (113 right and 133 left) total knee prosthesis operations performed by two right-handed orthopaedic surgeons in our institution were included. Patients were divided into right and left knee arthroplasty groups for comparison. The demographic data of the patients, the knee range of motion (ROM), hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and Knee Society Score (KSS) values were evaluated for all groups. Moreover, electromyographic measurements of specific muscle groups, which were used while performing the right and left total knee arthroplasty procedures, were taken for the two surgeons to compare the differences in efficacy of surgeries performed on different sides.

Results: There was no statistically significant difference between the two groups when the postoperative bleeding volumes and flexion, extension levels, and pain and function scores at 3 months and 1 year were compared There was no significant difference between groups in term of postoperative ROM, HKAA, LDFA, MPTA, and KSS values. It was observed that the right latissimus dorsi muscles of the surgeons exhibited about five times more activation, the left latissimus dorsi muscles exhibited three times more activation, and the left gluteus medius muscles exhibited two times more activation during left knee surgery than right knee surgery.

Conclusion: Right-handed surgeons can provide equally good results when operating left knees as right ones, although they exert more effort when performing left-sided arthroplasty. However, we conclude that left knee surgeries cause more occupational damage for surgeons.

Keywords

• arthroplasty
• laterality
• surgeon
• surgery
• total knee arthroplasty

Sol Total Diz Artroplastisi Sağ El Dominant Cerrah İçin Neden Daha Zordur? Total Diz Artroplastisinde Taraf Analizi

Abstract

Amaç: Bizim hipotezimiz, sağ elini kullanan cerrahların sol tarafta diz artroplastisi yaparken daha fazla mesleki hasara maruz kalmalarına rağmen, her iki tarafa artroplastilerde eşit başarılı sonuçlar elde edebilmesidir.

Gereç ve Yöntemler: Kurumumuzda çalışan 2 sağ el dominant Ortopedi cerrahı tarafından gerçekleştirilen toplam 246 (113 sağ ve 133 sol) total diz protezi operasyonu çalışmaya dahil edildi. Karşılaştırma için hastalar sağ ve sol diz artroplastisi gruplarına ayrıldı. Hastaların demografik verileri, eklem hareket açıklığı (EHA), kalça-diz-ayak bileği açısı (KDAA), lateral-distal-femoral açı (LDFA), medial-proksimal-tibial açı (MPTA) ölçümleri ve Diz Derneği Skorları (KSS) değerlendirildi. Ayrıca sağ ve sol total diz artroplastisi işlemleri yapılırken kullanılan spesifik kas gruplarının elektromiyografik ölçümü, farklı taraflara yapılan ameliyatların etkinlik farklarını karşılaştırmak amacıyla 2 cerrah için ayrı ayrı yapıldı.

Bulgular: Postoperatif kanama hacimleri ile 3. ay ve 1. yıldaki fleksiyon, ekstansiyon açıları, ağrı ve fonksiyon skorları karşılaştırıldığında 2 grup arasında istatistiksel olarak anlamlı fark yoktu. Postoperatif EHA, KDAA, LDFA, MPTA ve KSS değerleri açısından gruplar arasında anlamlı farklılık yoktu. Sol diz cerrahisinde sağ diz cerrahisine göre cerrahların sağ latissimus dorsi kasının yaklaşık 5 kat, sol latissimus dorsi kasının 3 kat, sol gluteus medius kasının 2 kat daha fazla aktivasyon sergilediği görüldü.

Sonuç: Sağ elini kullanan cerrahlar, sol tarafa diz artroplastisi yaparken daha fazla çaba sarf etseler de sağ tarafa uygulanan cerrahiler kadar iyi sonuçlar sağlayabilmektedirler. Ancak sol diz ameliyatlarının sağ elini dominant olarak kullanan cerrahlar için daha fazla mesleki zarara neden olduğunu düşünüyoruz.

Keywords

• artroplasti
• cerrahi
• cerrah
• taraf
• total diz artroplastisi

References

1. 1. Lau RL, Perruccio AV, Gandhi R, Mahomed NN. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord. 2012;14;13:250. Doi:10.1186/1471-2474-13-250 .
2. 2. Erkan S, Yercan HS, Okcu G, Ozalp RT. Total diz artroplastisi sonrası diz sertliğine neden olan faktörler. Eklem Hastalık Cerrahisi. 2011;22(1):16-21.
3. 3. Lui DF, Baker JF, Nfila G, Perera A, Stephens M. Hand dominance in orthopaedic surgeons. Acta Orthop Belg. 2012;78(4):531-7.
4. 4. Mehta S, Lotke PA. Impact of surgeon handedness and laterality on outcomes of total knee arthroplasties: should right-handed surgeons do only right TKAs? Am J Orthop (Belle Mead NJ). 2007;36(10):530-3.
5. 5. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;11(248):13-4.
6. 6. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10(5):361-74.
7. 7. Hislop H.J., Avers D., Brown M. Testing the Muscles of the Upper Extremity. In: Hislop H.J., Avers D., Brown M. eds. Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination. 9th ed. China.Saunders, 2013:79-199.
8. 8. De Mey K, Danneels LA, Cagnie B, Huyghe L, Seyns E, Cools AM. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther. 2013;43(1):3-10.

9. 9. Beaudette SM, Unni R, Brown SH. Electromyographic assessment of isometric and dynamic activation characteristics of the latissimus dorsi muscle. J Electromyogr Kinesiol. 2014;24(3):430-6.
10. 10. Hislop H.J., Avers D., Brown M. Testing the Muscles of the Lower Extremity. In: Hislop H.J., Avers D., Brown M. eds. Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination. 9th ed. China. Saunders, 2013:203-275.
11. 11. Pennington N, Redmond A, Stewart T, Stone M. The impact of surgeon handedness in total hip replacement. Ann R Coll Surg Engl. 2014;96(6):437-41.
12. 12. Buyukdogan K, Utsunomiya H, Bolia I, Fagotti L, Lebus GF, Briggs KK et al. Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve. Arthrosc Tech. 2017;6(5):e1837-44.
13. 13. Moloney D, Bishay M, Ivory J, Pozo J. Failure of the sliding hip screw in the treatment of femoral neck fractures: ‘left-handed surgeons for left-sided hips’. Injury. 1994;25(Suppl 2):B9-13.
14. 14. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86(9):1909-16.
15. 15. Penney T, Ploughman M, Austin MW, Behm DG, Byrne JM. Determining the activation of gluteus medius and the validity of the single leg stance test in chronic, nonspecific low back pain. Arch Phys Med Rehabil. 2014;95(10):1969-76.
16. 16. Arab AM, Nourbakhsh MR. The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain. Chiropr Osteopat. 2010;18:1. Doi:10.1186/1746-1340-18-1.
17. 17. Soueid A, Oudit D, Thiagarajah S, Laitung G. The pain of surgery: pain experienced by surgeons while operating. Int J Surg. 2010;8(2):118-20.
18. 18. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surgical Endoscopy. 2007;25(11):1965-9.