Automatic Impactors in Total Hip Arthroplasty: A State-of-the-Art Review.

BACKGROUND: Total hip arthroplasty places considerable physical strain on orthopaedic surgeons over time and requires precise impaction for optimal implant fixation. Automated impactors have emerged as innovative tools to address the limitations of mallets, with efforts to improve the surgeon's physical health, efficiency, and patient outcomes. This review evaluated the specifications, clinical applications, ergonomic benefits, and occupational hazards of 4 commercially available automated impactors. This was compared to existing literature on the devices and supplemented with independent noise measurements. METHODS: A systematic PubMed search (from 2013 to 2024) identified 147 relevant articles after excluding studies on impaction grafting and trauma. Product specifications and noise data were supplemented with patent information and manufacturer details. Noise mitigation strategies and ergonomic considerations were also explored. Sound levels of 3 of the discussed impactors were measured to supplement this review. RESULTS: Automated impactors demonstrated significant reductions in femoral broaching time, improved consistency, and reduced surgeon fatigue compared to manual methods. Periprosthetic fracture risk was equal to or less than that of manual broaching. Each impactor exhibited unique strengths-KINCISE offered versatility, Woodpecker precision, HAMMR adjustability, and orthodrive the lowest noise production among the devices measured. Time-weighted average noise levels ranged from 57.37 to 67.47 dBA across devices, with maximum levels ranging from 101.2 to 107.3 dBA, remaining below the Occupational Safety and Health Administration time-weighted average threshold of 85 dBA and the World Health Organization maximum threshold of 110 dBA. CONCLUSIONS: Automated impactors enhance procedural efficiency and ergonomics in total hip arthroplasty, but device selection should be tailored to specific surgical and institutional needs. Noise levels were similar across devices, though close to the World Health Organization maximum threshold. Future research should focus on long-term patient outcomes and standardizing testing protocols for these devices.

Duke Scholars

Author Thorsten Markus Seyler Orthopaedic Surgery