Ergonomics in the OR cannot be overlooked

Orthopaedic surgery demands precision, endurance, and strength. Although surgeons train intensely to master surgical techniques, manage complications, and restore function in their patients, it is easy to overlook the long-term toll that their work can take on their own bodies. Across specialties, orthopaedic surgeons report some of the highest rates of work-related musculoskeletal injuries. The irony is unmistakable: Those who care for bones, joints, and soft tissues often do so at the expense of their own.

The data are both clear and concerning. Studies show that more than 60% of orthopaedic surgeons experience occupational musculoskeletal symptoms. Common complaints include neck and back pain, rotator cuff strain, lateral epicondylitis, carpal tunnel syndrome, and chronic fatigue. These injuries are frequently tied to poor posture during surgery, repetitive motion, sustained static positions, and the physical strain of handling instruments, retractors, or heavy lead aprons. Over time, these issues contribute to reduced clinical productivity, increased time off work, diminished job satisfaction, and even early retirement in some cases.

The concept of ergonomics, the science of designing work environments and tasks to fit the capabilities and limitations of the human body, is not new. Yet, in the culture of surgical practice, ergonomics has often taken a back seat to efficiency and endurance. There is still a deeply ingrained mindset that discomfort is simply part of the job, a rite of passage. This perception is not only outdated but dangerous. Just as surgeons would never advise a patient to ignore early signs of overuse or pain, they must stop dismissing their own.

Ergonomics should be considered a core element of surgical safety, not only for the patient but also for the surgeon. Fortunately, integrating ergonomic principles into daily practice does not require expensive equipment or dramatic workflow changes. Rather, it begins with awareness and small, deliberate adjustments.

Ergonomics in the OR
In the OR, table height is a critical factor. A table that is too high or too low can force the surgeon into poor posture, leading to shoulder and back strain. Adjusting table height to allow for neutral arm and wrist positions, ideally with elbows at a 90-degree angle, can make a significant difference over a long case. The placement of monitors should also be evaluated. Monitors positioned too far to the side or below eye level encourage cervical rotation and flexion, leading to neck fatigue. Simple reorientation of screens and equipment carts can improve visibility and reduce strain.

Instrument design also plays a role. Choosing ergonomic, lightweight, and balanced tools can reduce wrist and hand fatigue, particularly during procedures requiring fine motor control or repetitive motion. Battery-powered instruments can offload effort during reaming, sawing, or drilling, especially in joint arthroplasty or trauma cases. Additionally, surgical teams should be encouraged to standardize room setups in ways that minimize unnecessary movement or awkward positioning, as well as coordinate with OR staff to anticipate ergonomic needs — such as proper stool height, foot-pedal placement, and light positioning.

Importantly, incorporating “microbreaks” during surgery can combat the cumulative effects of static postures. Studies suggest that even brief 20- to 30-second pauses every 30 minutes, with active movement or stretching, can reduce fatigue and musculoskeletal strain without compromising surgical flow. These practices may seem minor, but over a career spanning decades, they add up to significant risk reduction.

Beyond the OR, ergonomics extends into the clinic and office settings. Many orthopaedic surgeons spend long hours at computer workstations documenting care, reviewing imaging, and coordinating with colleagues. Use of adjustable chairs, lumbar support, sit-stand desks, and ergonomically designed keyboards can help prevent repetitive strain injuries. Encouraging healthy posture and regular movement breaks among office staff and residents reinforces a culture that prioritizes physical wellness.

Investing in ergonomics
Education is perhaps the most critical and underutilized tool in ergonomic safety. Ergonomics should be stressed from the earliest stages of surgical training. Just as surgeons are instructed in sterile technique and complication management, they must learn to recognize and mitigate risks to their own musculoskeletal systems. Residency programs should include formal training on ergonomic setup, positioning, and prevention of overuse injuries. Simulation labs can integrate ergonomic assessments alongside technical skill evaluation. And most importantly, faculty and senior surgeons must model these principles, demonstrating that prioritizing personal safety is not weakness, but wisdom.

Ergonomics should also be part of institutional and specialty-wide wellness initiatives. Hospital systems should support ergonomic assessments, make adaptive equipment available, and create feedback loops for surgeons to suggest improvements in workflow. Orthopaedic societies such as AAOS can play a role by advocating for research, guidelines, and awareness campaigns that promote surgeon health and safety.

Ultimately, the goal is to not just reduce discomfort but also extend the careers, capabilities, and well-being of the people behind the procedures. When surgeons are in pain, their ability to care for patients, teach residents, and innovate in their field is compromised. By embedding ergonomics into the fabric of their practice, orthopaedic surgeons invest not only in their own health but also in the future of the specialty.

Orthopaedic surgery is a physically demanding profession, but that does not mean it should come at the cost of the surgeon’s own physical health. With intention, education, and small changes, the orthopaedic community can create a culture where surgeon wellness is a priority, not a luxury.

Let us not wait until we are patients ourselves to take this seriously!

Sean A. Tabaie, MD, MBA, FAAOS, is a pediatric orthopaedic surgeon at Nationwide Children’s Hospital and an associate professor in the Department of Orthopaedic Surgery at the Ohio State University in Columbus, where he leads the neuro-orthopaedics program and serves as medical director of the Honda Center for Gait Analysis and Mobility Enhancement. Dr. Tabaie is also a member of the AAOS Board of Directors.