Noise Levels and Noise-Induced Hearing Loss in the Orthopaedic Operating Room: A Systematic Review.

Abstract

Orthopaedic personnel are routinely exposed to noise from saws, drills, and hammers that exceeds safety thresholds, placing them at significant risk of noise-induced hearing loss (NIHL). Despite this hazard, preventive measures remain infrequently used. This systematic review evaluates NIHL prevalence, intraoperative noise, and effectiveness of protective measures in operating rooms. Studies on the prevalence, risk, and prevention of NIHL in orthopaedic personnel published before July 21, 2025 were screened from PubMed/Medline, Ovid Embase, and CENTRAL (Cochrane). Thirty-four studies met the inclusion criteria. NIHL was identified in 17% of participants, and 56 of 75 surgical instruments exceeded the National Institute for Occupational Safety and Health (NIOSH) A-weighted limits. Noise levels were consistently unsafe during total hip and knee arthroplasty, particularly when robotic-assisted. Custom hearing protection with interchangeable noise reduction filters reduced exposure while maintaining intraoperative communication, whereas surgical hood systems showed minimal benefit, and active noise-cancelling headphones had mixed results. Orthopaedic personnel are frequently exposed to noise levels exceeding safety thresholds, especially during robotic-assisted total knee arthroplasty, placing them at risk for NIHL. Evidence supports using custom hearing protection with communication-preserving filters, developing quieter surgical equipment, and implementing routine hearing assessments to improve long-term hearing outcomes. II.