Becker's ASC Review

55 Executive Briefing Sponsored by: The need for Efficiency Total knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure for alleviating pain, restoring function and enabling a higher quality of life for patients with advanced osteoarthritis. These positive outcomes have driven significant growth in the number of TKA procedures performed globally. In the United States alone, the number of procedures is projected to increase from 693,400 cases in 2010 to 3.5 million cases by 2030 1,2 . At an average hospital cost of $16,000 per case, knee arthroplasties in the U.S. exceeded $11 billion in 2010 1 . As a response to escalating costs, the U.S. healthcare system is evolving from a fee-for-service system to a value-based system that incentivizes quality care delivered under controlled costs. For total joint replacement, CMS is currently trialing the Comprehensive Care for Joint Replacement (CJR) model, which holds hospitals financially accountable for the quality and global cost of care from patient admission through 90 days post-discharge. With these changes in reimbursement, providers must evaluate all aspects of TKA procedures to ensure financial viability while delivering high quality care. In turn, there is a strong focus on controlling operating costs, minimizing post-discharge complications, and optimizing the utilization and scheduling of operating rooms. Streamlining the surgical instrumentation is a key area for improving efficiency in the OR as well as hospital operations, particularly for outpatient TKA and ambulatory surgery centers. Single-use, sterile-packed instrumentation can help control costs while improving quality and efficiency. Multiple studies have suggested that reusable instrumentation may be associated with surgical site infections, which could be avoided with single-use instruments 3-5 . Single-use instruments also means fewer trays that need to be sterilized for each case, translating to substantial cost reductions and logistical improvements. OR setup and cleanup time is also reduced during case turnover 5 , which is an important focus for improving hospital efficiencies and OR utilization. Finally, reusable instrument sets for TKA are typically loaned to the facility by a manufacturer and the logistics associated with managing the intake, processing, and transport can be highly burdensome. The GMK® Efficiency single-use Instruments from Medacta International of Castel San Pietro, Switzerland, come terminally sterile and can streamline the instrumentation logistics and OR turnover for each TKA case, as all of the opened Efficiency instruments and trays are disposed of at the end of the case (Figure 1A). The durability and functionality of these instruments was attained through attention to design detail and the combination of special medical grade composite technopolymers with high precision manufacturing processes. These instruments can be used in combination with reusable or patient-specific cutting blocks, such as MyKnee® Patient Matched Instrumentation. A. B. Figure 1. A) Efficiency instruments for a TKA case vs. B) reusable instruments required for a TKA case. Neither case uses patient- specific cutting blocks. Note the lack of four extra trays in the top of image (A) vs. (B). Costs and logistical considerations of TKA vary dramatically between different facilities, surgeons, and cases, so it is difficult to study the economic advantages of single-use instruments directly. Cost modeling through probabilistic simulations provides insights into the range of potential savings under a wide variety of scenarios. A cost model was developed to explore the potential cost savings for TKA procedures performed with GMK Efficiency instruments compared with traditional, reusable instruments based on a variety of clinical events (e.g. infections), economic conditions (e.g. staff wages) and logistical variables (e.g. OR turnover). Economic Advantages of Medacta's Sterile-packed, GMK® Efficiency Single-use Instruments for Total Knee Arthroplasty By Tyler Goldberg, MD a ; Jason A. Inzana, PhD b , John A. Maltry, MD c a Texas Orthopedics, Sports and Rehabilitation Associates; Austin, TX, USA b Telos Partners, LLC; Denver, CO, USA c Tucson Orthopaedic Institute; Tucson, AZ, USA 1 Williams, S., Wolford, M. & Bercovitz, A. Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000–2010. NCHS data brief, no 210. Hyattsville, MD: National Center for Health Statistics. (2015). 2 Kurtz, S., Ong, K., Lau, E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89:780-785. 3 Dancer, S. J., Stewart, M., Coulombe, C. et al. Surgical site infections linked to contaminated surgical instruments. J Hosp Infect 2012; 81:231-238. 4 Mont, M. A., Johnson, A. J., Issa, K. et al. Single-use instrumentation, cutting blocks, and trials decrease contamination during total knee arthroplasty: a prospective comparison of navigated and nonnavigated cases. J Knee Surg 2013; 26:285-290. 5 Siegel, G. W., Patel, N. N., Milshteyn, M. A. et al. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation. J Arthroplasty 2015; 30:2271-2274.

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