{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:00:52Z","timestamp":1775559652283,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic working-height recommendations in orthopaedic surgery remains limited. Methods: A simulated left total knee arthroplasty (TKA) was divided into twelve critical surgical steps and analysed across four commonly used surgeon positions (A\u2013D). Two conditions were compared: uncorrected working height (N) and working height corrected according to Canadian Centre for Occupational Health and Safety (CCOHS) recommendations (C). Joint angles were measured from standardized photographs using Kinovea software, and postural load was quantified with the Rapid Entire Body Assessment (REBA) method. Two trained evaluators conducted three independent assessments, yielding 288 REBA scores. Results: Mean REBA scores decreased across all surgeon positions following ergonomic correction, with statistically significant reductions observed in positions A, B, and D. When pooled across all position\u2013step combinations (n = 48), the mean reduction was 0.92 REBA points (95% CI 0.50\u20131.33; p &lt; 0.001). Notably, 27 of the 48 position\u2013step comparisons exceeded the minimal detectable change threshold. The largest reductions occurred during force-intensive surgical steps, including bone cutting, drilling, and implant impaction. Conclusions: Adjusting working height in accordance with CCOHS ergonomic recommendations reduces surgeons\u2019 postural load during TKA. These findings support the integration of evidence-based ergonomic adjustments into routine orthopaedic surgical practice.<\/jats:p>","DOI":"10.3390\/jcm15072782","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:40:31Z","timestamp":1775554831000},"page":"2782","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Operating Table Height Optimization Reduces Surgeon Postural Load During Total Knee Arthroplasty: An Ergonomic Simulation Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1434-6083","authenticated-orcid":false,"given":"Marina","family":"S\u00e1nchez-Robles","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Rafael M\u00e9ndez, Lorca, 30817 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0551-0341","authenticated-orcid":false,"given":"Carmelo","family":"Mar\u00edn-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sof\u00eda, 30003 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0429-2579","authenticated-orcid":false,"given":"Vicente J.","family":"Le\u00f3n-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sof\u00eda, 30003 Murcia, Spain"},{"name":"Instituto Murciano de Investigaci\u00f3n Biosanitaria Pascual Parrilla (IMIB), 30120 Murcia, Spain"},{"name":"Instituto de Cirug\u00eda Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3520-2521","authenticated-orcid":false,"given":"Joaqu\u00edn","family":"Moya-Angeler","sequence":"additional","affiliation":[{"name":"Instituto de Cirug\u00eda Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain"},{"name":"Olympia Medical Centre, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1082-6346","authenticated-orcid":false,"given":"Francisco","family":"Lajara-Marco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sof\u00eda, 30003 Murcia, Spain"},{"name":"Instituto Murciano de Investigaci\u00f3n Biosanitaria Pascual Parrilla (IMIB), 30120 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/CORR.0000000000002904","article-title":"High prevalence of work-related musculoskeletal disorders and limited evidence-based ergonomics in orthopaedic surgery: A systematic review","volume":"482","author":"Vasireddi","year":"2024","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e174947","DOI":"10.1001\/jamasurg.2017.4947","article-title":"Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: A systematic review and meta-analysis","volume":"153","author":"Epstein","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3928\/01477447-20230224-05","article-title":"Orthopedists report high prevalence of work-related pain and low ergonomic awareness","volume":"46","author":"Buddle","year":"2023","journal-title":"Orthopedics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.5435\/JAAOS-D-24-01206","article-title":"Ergonomics in the operating room: Recommendations for orthopaedic surgeons","volume":"33","author":"Valtanen","year":"2025","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. (2023). Fair healthcare practices in orthopedics assessed with a new framework. Healthcare, 11.","DOI":"10.3390\/healthcare11202753"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Aaron, K.A., Vaughan, J., Gupta, R., Ali, N.-E., Beth, A.H., Moore, J.M., Ma, Y., Ahmad, I., Jackler, R.K., and Vaisbuch, Y. (2021). The risk of ergonomic injury across surgical specialties. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0244868"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E250","DOI":"10.1097\/BRS.0000000000005055","article-title":"Ergonomics in spine surgery: A systematic review","volume":"49","author":"Alostaz","year":"2024","journal-title":"Spine"},{"key":"ref_8","first-page":"1627","article-title":"Ergonomic considerations in open liver surgery","volume":"29","author":"Haddad","year":"2025","journal-title":"J. Gastrointest. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.surg.2023.04.003","article-title":"Ergonomic problems, principles and potential solutions in surgical operations","volume":"174","author":"Barrios","year":"2023","journal-title":"Surgery"},{"key":"ref_10","first-page":"458","article-title":"Operating room ergonomics needs and priorities: A survey of operating room staff","volume":"279","author":"Mah","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_11","unstructured":"Canadian Centre for Occupational Health and Safety (2023, March 03). Working in a Standing Position\u2014Basic Information. CCOHS. Available online: https:\/\/www.ccohs.ca\/oshanswers\/ergonomics\/standing\/standing_basic.html."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hita-Guti\u00e9rrez, M., G\u00f3mez-Gal\u00e1n, M., D\u00edaz-P\u00e9rez, M., and Callej\u00f3n-Ferre, \u00c1.J. (2020). An overview of REBA method applications in the world. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17082635"},{"key":"ref_13","unstructured":"Instituto Nacional de Seguridad y Salud en el Trabajo (2003). NTP 601: Evaluaci\u00f3n de las Condiciones de Trabajo. M\u00e9todo REBA, INSST."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"C\u0103teanu, A.M.L., Repanovici, A., Baritz, M.I., Scutariu, M.M., Ostafe, A.I.T., and Pantea, I. (2024). Postural risks in dental practice: An assessment of musculoskeletal health. Sensors, 24.","DOI":"10.3390\/s24196240"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00140139.2025.2575065","article-title":"REBA integrated with organisational analysis to assess the risk of biomechanical overload in physiotherapists","volume":"68","author":"Tasso","year":"2025","journal-title":"Ergonomics"},{"key":"ref_16","first-page":"e53698","article-title":"An ergonomic risk assessment of ophthalmology residents using the Rapid Entire Body Assessment (REBA) scale","volume":"16","author":"Morrison","year":"2024","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.gie.2023.05.055","article-title":"ASGE guideline on the role of ergonomics for prevention of endoscopy-related injury: Methodology and review of evidence","volume":"98","author":"Pawa","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Robles, M., D\u00edaz-Mart\u00ednez, F.J., Le\u00f3n-Mu\u00f1oz, V.J., Mar\u00edn-Mart\u00ednez, C., Murcia-Asensio, A., Moreno-Cascales, M., and Lajara-Marco, F. (2023). Ergonomic evaluation of different surgeon positions for total knee arthroplasty surgery. Appl. Sci., 13.","DOI":"10.3390\/app132111842"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Puig-Div\u00ed, A., Escalona-Marfil, C., Padull\u00e9s-Riu, J.M., Busquets, A., Padull\u00e9s-Chando, X., and Marcos-Ruiz, D. (2019). Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in four perspectives. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216448"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1007\/s00464-001-8190-y","article-title":"Assessment of the ergonomically optimal operating surface height for laparoscopic surgery","volume":"16","author":"Jakimowicz","year":"2002","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s00464-008-0068-9","article-title":"Ergonomic assessment of optimum operating table height for hand-assisted laparoscopic surgery","volume":"23","author":"Manasnayakorn","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jacquier-Bret, J., and Gorce, P. (2023). Prevalence of body area work-related musculoskeletal disorders among healthcare professionals: A systematic review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20010841"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ygyno.2012.05.016","article-title":"Physical strain and need for ergonomic training among gynecologic oncologists","volume":"126","author":"Kriseman","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jmig.2013.04.008","article-title":"Ergonomic deficits in robotic gynecologic oncology surgery","volume":"20","author":"Arden","year":"2013","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.jamcollsurg.2019.12.035","article-title":"Impact of procedure type, case duration, and adjunctive equipment on surgeon intraoperative musculoskeletal discomfort","volume":"230","author":"Yang","year":"2020","journal-title":"J. Am. Coll. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6335","DOI":"10.1007\/s00464-020-08085-3","article-title":"Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery","volume":"35","author":"Yang","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"8178","DOI":"10.1007\/s00464-022-09256-0","article-title":"Surgeons\u2019 physical workload in open surgery versus robot-assisted surgery and non-surgical tasks","volume":"36","author":"Fan","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_28","first-page":"214","article-title":"Core curriculum for ergonomics in endoscopy","volume":"53","author":"Walsh","year":"2021","journal-title":"Endoscopy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1097\/SLA.0000000000002592","article-title":"The current state of surgical ergonomics education in U.S. surgical training: A survey","volume":"269","author":"Epstein","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.jsurg.2020.11.004","article-title":"Incorporating surgical ergonomics education into surgical residency curriculum","volume":"78","author":"Jensen","year":"2021","journal-title":"J. Surg. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jss.2023.08.021","article-title":"Working Through the Pain: A Cross-Sectional Survey on Musculoskeletal Pain Among Surgeons and Residents","volume":"293","author":"Shah","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jss.2022.06.014","article-title":"Ergonomics workshop improves musculoskeletal symptoms in general surgery residents","volume":"280","author":"Cerier","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/SLA.0000000000003199","article-title":"A preventive program for work-related musculoskeletal disorders among surgeons: Outcomes of a randomized controlled clinical trial","volume":"270","author":"Giagio","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7805205090","DOI":"10.5014\/ajot.2024.050395","article-title":"Preventing surgeon work-related musculoskeletal disorders: A pilot study of the comprehensive operating room ergonomics (CORE) program","volume":"78","author":"Hess","year":"2024","journal-title":"Am. J. Occup. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Restaino, S., D\u2019indinosante, M., Perelli, F., Arcieri, M., Cherchi, V., Petrillo, M., Cavaliere, A.F., Cianci, S., Pellecchia, G., and Meniconi, R.L. (2024). Ergonomics in the operating room and surgical training: A survey on the Italian scenario. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1417250"},{"key":"ref_36","first-page":"204","article-title":"A review of the ergonomic issues in the laparoscopic operating room","volume":"36","author":"Choi","year":"2012","journal-title":"J. Med. Eng. Technol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103570","DOI":"10.1016\/j.ergon.2024.103570","article-title":"Application of wearable technology for ergonomic risk assessment of healthcare professionals: A systematic review","volume":"100","author":"Sabino","year":"2024","journal-title":"Int. J. Ind. Ergon."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Santos, W., Rojas, C., Isidoro, R., Lorente, A., Dias, A., Mariscal, G., Benlloch, M., and Lorente, R. (2025). Efficacy of ergonomic interventions on work-related musculoskeletal disorders: A systematic review and meta-analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093034"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2782\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T10:07:58Z","timestamp":1775556478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072782"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072782","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]}}}