Table 3.

Hazards of the orthopaedic work environment

Hazard	Risk	Evidence	Mitigation Strategies
Exposure to radiation	Potential effects on the fetus include [15]:  - Prenatal death - Growth restriction - Microsomia - Severe mental retardation - Organ malformation - Childhood cancer	Conflicting evidence on radiation exposure when wearing standard (0.25-mm) lead aprons: - Measurable radiation exposure under a standard apron, varied by procedure [30] - No exposure during fluoroscopic procedures [8]	- Standard lead apron [8,15] - Fetal lead apron [15] - Personal dosimeter at collar height [8] and over abdomen [15] - Increasing distance from radiation source [15] - Abstaining from participation in fluoroscopic procedures [30]
Exposure to MMA	Potential effects on the fetus include [15]:  - Gross and skeletal fetal abnormalities - Reduction in fetal weight	- MMA not a serious hazard when PPE used [8] - MMA levels were not elevated in orthopaedic surgeons’ breast milk postarthroplasty [17]	- Use of vacuum mixer [8,15] - Use of personal hood [8,15] - Room air exchange [15] - Local surgical field suction [15] - Scrubbing out during cement phase of surgery [17]
Exposure to anesthetic gases	At high doses, anesthetic gases have fetotoxic effects [15]	- Waste levels of anesthesia gases had minimal risk to pregnant surgeons [8] - Fetotoxic effects not found at doses used for general anesthetic [15]	- None provided
Exposure to bloodborne pathogens	Potential effects on the fetus include [15]: - Prenatal death - Vertical transmission HIV postexposure prophylaxis (AZT) may be mutagenic [15]	- Transmission risks from percutaneous exposure vary from 0.3% (HIV) to 30% (hepatitis B) [8] - Maternofetal transmission risks well documented, risk up to 90% for hepatitis B infection in third trimester [8]	- Personal protective equipment, including glove liners and full-facial coverage [8] - Postexposure prophylaxis - Discontinue breast feeding if taking AZT [15]
High physical demands	Potential effects on the fetus include [8]: - Preterm labour - Preeclampsia - IUGR	- 20% to 30% maximum aerobic capacity during surgery, risks due to strenuous activity low [8] - No correlation between time in the operating room and rate of pregnancy complication, despite physical demand [14]	-  None provided
Extended duty hours	- Decreased water intake, lack of time for pumping when lactating can lead to mastitis and blocked ducts [17]	- Orthopaedic surgeons found to have increased risk of complications if working > 60 hours per week [14]	-  None provided

MMA = methyl methacrylate; AZT = azidothymidine; IUGR = intrauterine growth restriction.