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Musculoskeletal disorders (MSDs) among orthopaedic surgeons are associated with sustained, constrained postures during demanding intraoperative tasks. Total hip arthroplasty (THA) comprises sequential steps that may impose different postural loads on both the surgeon and assistant, yet team-level ergonomic design interventions remain underexplored. This study compared ergonomic risk during primary THA performed through the direct lateral (modified Hardinge) and posterolateral (Moore) approaches and assessed a simple workflow redesign: swapping surgeon and assistant positions during acetabular cup preparation (bottom reaming, perimeter reaming, and cup impaction). In a controlled Sawbones-based simulation using standard THA instruments, eight standardised surgical steps were recorded with 360° photographs. Forty-two postural instances (22 for the surgeon, 20 for the assistant) were analysed. Joint angles were measured with Kinovea and converted to Rapid Entire Body Assessment (REBA) scores; intra- and inter-rater reliability (ICC) and minimum detectable change (MDC95) were calculated. Surgeon REBA scores were in the medium-risk range and slightly lower with the posterolateral approach (mean 5.5) than with the direct lateral approach (mean 5.88), whereas assistant scores were in the low-risk range (means 3.43 and 3.29, respectively). The position-swap intervention successfully lowered the surgeon’s REBA action level, most notably during cup impaction, where ergonomic risk dropped from 10 (high risk) to 4 (medium risk) in the posterolateral approach, and from 7 (medium risk) to 3 (low risk) in the direct lateral approach, without increasing assistant risk. These findings provide controlled simulation-based evidence that this simple, zero-cost positional change can reduce the surgeon’s ergonomic action level during THA, although confirmation under real operative conditions is needed before broad generalization.

Ergonomics and risk factors for work-related musculoskeletal disorders have been studied extensively in various industry fields. However, only a few decades ago, these issues became a concern in the healthcare sector. Total knee arthroplasty (TKA) is one of the most common procedures performed by orthopaedic surgeons, and it would be desirable to perform it with an ergonomically safer technique. This study evaluated the ergonomic risk of different surgeon positions when performing contralateral TKA using the dominant hand. After the authors defined the four possible surgeon positions according to the most common positions used by surgeons in our environment (position A, on the opposite side of the knee to be operated on; position B, on the same side as the knee to be operated on; position C, with the patient’s legs separated and the surgeon standing between them; and position D, facing the knee to be operated on, at the patient’s feet), we performed an ergonomic analysis using the Rapid Entire Body Assessment (REBA) method. The overall REBA scores (lower score values indicate better ergonomics than higher) were between 7 and 6.5 for position A, between 6.17 and 5.5 for position B, between 5.92 and 5.5 for position C, and between 3.75 and 3.42 for position D. The test–retest and inter-rater reliability values ranged from substantial agreement to almost perfect agreement. Based on the results, we can conclude that the most ergonomic position for a right-handed surgeon to perform a left TKA is facing the left knee, at the patient’s feet (position D).

Introduction. Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup. Methods. We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion. Results. The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation in the midterm follow-up did not show mobilization of implants. Discussion. The use of metal porous augments is widely used for severe acetabular defects, being a versatile system to adapt to the different size defects. Nevertheless, its use may be technically demanding and time consuming. It is not infrequent that the setting of the augments conditions the final position of the cup with a possible interference with initial stability and eventually bone ingrowth of the cup. The interlocking mechanism offers an additional biomechanical stability and thus may allow us to place the cup first in the desired position with a less demanding technique. Conclusion. With the use of locked-screw porous metal cups, the order of setting of implants may be changed in order to obtain a better restoration of the center of rotation and increased host-bone implant contact with a simplified surgical technique.