Noise Levels and Noise-Induced Hearing Loss in the Orthopaedic Operating Room: A Systematic Review.

Background: Orthopaedic personnel are routinely exposed to noise from saws, drills, and hammers that exceeds safety thresholds, placing them at significant risk of noise-induced hearing loss (NIHL). Despite this hazard, preventive measures remain infrequently used. This systematic review evaluates NIHL prevalence, intraoperative noise, and effectiveness of protective measures in operating rooms. Methods: Studies on the prevalence, risk, and prevention of NIHL in orthopaedic personnel published before July 21, 2025 were screened from PubMed/Medline, Ovid Embase, and CENTRAL (Cochrane). Thirty-four studies met the inclusion criteria. Results: NIHL was identified in 17% of participants, and 56 of 75 surgical instruments exceeded the National Institute for Occupational Safety and Health (NIOSH) A-weighted limits. Noise levels were consistently unsafe during total hip and knee arthroplasty, particularly when robotic-assisted. Custom hearing protection with interchangeable noise reduction filters reduced exposure while maintaining intraoperative communication, whereas surgical hood systems showed minimal benefit, and active noise-cancelling headphones had mixed results. Conclusions: Orthopaedic personnel are frequently exposed to noise levels exceeding safety thresholds, especially during robotic-assisted total knee arthroplasty, placing them at risk for NIHL. Evidence supports using custom hearing protection with communication-preserving filters, developing quieter surgical equipment, and implementing routine hearing assessments to improve long-term hearing outcomes. Level of Evidence: II.