Full of sound and fury.

The subject of noise in the operating theatre was recognized as early as 1972 and has been compared to noise levels on a busy highway. While noise-induced hearing loss in orthopaedic surgery specifically has been recognized as early as the 1990s, it remains poorly studied. As a result, there has been renewed focus in this occupational hazard. Noise level is typically measured in decibels (dB), whereas noise adjusted for human perception uses A-weighted sound levels and is expressed in dBA. Mean operating theatre noise levels range between 51 and 75 dBA, with peak levels between 80 and 119 dBA. The greatest sources of noise emanate from powered surgical instruments, which can exceed levels as high as 140 dBA. Newer technology, such as robotic-assisted systems, contribute a potential new source of noise. This article is a narrative review of the deleterious effects of prolonged noise exposure, including noise-induced hearing loss in the operating theatre team and the patient, intraoperative miscommunication, and increased cognitive load and stress, all of which impact the surgical team's overall performance. Interventions to mitigate the effects of noise exposure include the use of quieter surgical equipment, the implementation of sound-absorbing personal protective equipment, or changes in communication protocols. Future research endeavours should use advanced research methods and embrace technological innovations to proactively mitigate the effects of operating theatre noise.
Competing Interests: F. S. Haddad reports a grant from Stryker, related to this study, as well as multiple study grants from Stryker, Smith & Nephew, Corin, National Institute for Health and Care Research, and International Olympic Committee, royalties or licenses from Smith & Nephew, Stryker, Corin, and MatOrtho, consulting fees from Stryker, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker, Smith & Nephew, Zimmer, AO Recon, and Mathys, support for attending meetings and/or travel from Stryker, Mathys, AO Recon, and The Bone & Joint Journal, all of which are unrelated to this article. F. S. Haddad is also Editor-in-Chief of The Bone & Joint Journal, incoming President of the International Hip Society, and Vice President of the European Hip Society.
(© 2024 The British Editorial Society of Bone & Joint Surgery.)