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46 Executive Roundtable Sponsored by: How Single-use Instruments Facilitate Jump From Inpatient to Outpatient Total Knee Arthroplasty By Megan Wood A 2016 study published in the Jour- nal of Bone and Joint Surgery pre- dicts total knee arthroplasties will witness a 673 percent boost by 2030. In 2026, Sg2 analysts predict 52 percent of all primary knee replacements will occur in an outpatient setting, whether in a hospital outpatient department or ambulatory sur- gery center. Advancements in periopera- tive anesthesia and postoperative patient care have yielded reduced lengths of stay as well as decreased complications for TKA patients, according to Sg2 research. Driven by such a significant projected boost of total knee procedures, surgeons are seeking innovative technology and techniques to save time, limit processing costs and enhance accuracy when perform- ing these procedures as they transition to same-day surgery and outpatient settings. Tyler Goldberg, MD, of Austin-based Tex- as Orthopedics, Sports & Rehabilitation Associates, and Coleman Fowble, MD, of Columbia, S.C.-based Midlands Or- thopaedics & Neurosurgery, specifically prefer TKA technology adaptable to the outpatient setting and decided to lever- age Medacta's MyKnee Patient Specific Instrumentation in conjunction with Effi- ciency single-use instrumentation. When used with Medacta's Efficiency sin- gle-use instruments, Medacta's MyKnee patient-matched cutting block technolo- gy facilitates implantation of the Medacta GMK Sphere Total Knee Implant System during outpatient or same-day surgical procedures. The combination of these single-use instrument platforms has suc- cessfully reduced operative setup and breakdown times, instrument process- ing costs and time, storage space and weight. Terminally sterile, the platforms also reduce the need for a bulky steriliza- tion unit on the premises. Drs. Goldberg and Fowble discuss their experience performing TKAs in the outpa- tient setting with MyKnee PSI and Efficien- cy single-use instruments in conjunction with the Medacta GMK Sphere Total Knee Implant System. The GMK Sphere is a sag- ittally stable total knee implant system de- signed to reduce paradoxical motion and mid-flexion instability, potentially improv- ing patient satisfaction post-operatively. Question: Why and when did you start using the Medacta platform for total knee arthroplasty procedures? Do you perform the procedure inpatient same-day or outpatient? Dr. Tyler Goldberg: I started looking at utilizing the MyKnee patient-matched plat- form in December 2008. At that time, I was performing computer-assisted TKA. With computer-assisted orthopedic surgery, I was able to achieve great accuracy, but at additional expense of time, disposables and complexity to each case. Therefore, I was interested in finding a solution that would bring surgeons the accuracy of com- puter-assisted orthopedic surgery, but at conventional technique speed. To me, this required removing the computer from the OR and performing all the computer work (planning) prior to the operation. Medacta then put together a work group with me, Rob Greenhow, MD, and Craig Loucks, MD, both from Denver, and other surgeons in Europe to create what has become the MyKnee platform. I started utilizing the technique in my own patients in April 2010 and use it now for essential- ly 100 percent of my TKAs. I perform the procedure in both inpatient and outpa- tient settings. Dr. Coleman Fowble: I started using the MyKnee platform a year ago this month. I switched because I was having similar re- sults with the knee I was using as report- ed in the literature, which is only about a 75 percent to 80 percent excellent out- come. I moved over to this technology because I wanted to see if the Medacta MyKnee and Efficiency systems used with the GMK Sphere system would produce superior patient outcomes in terms of function and satisfaction. In 2013, our group started doing outpatient joints in our surgery center. So, the appeal of this disposable system from a cost stand- point gave me the best of both worlds. Q: How steep would you say the learning curve is for surgeons using Medacta MyKnee patient matched technology in conjunction with Ef- ficiency singe-use instruments to im- plant the Medacta GMK Sphere? What is the best way for a surgeon to tackle learning this procedure? TG: The learning curve for patient-matched technology in my opinion deals with two specific areas. First, is trusting the technol- ogy — will the instrument achieve the pre- planned result it was designed for? This natural "mistrust" of the instrumentation will cause the surgeon to do multiple checks and re-checks in their initial procedures to ensure accuracy of the TKA implantation. Second, is the simple act of registering, or placing, the instrument to the bone. The Medacta MyKnee technique provides pre- fabricated models of the knee so the sur- geon can trial the cutting guides prior to registering to the actual bone. Fortunately, both of these areas are learned concur- rently and usually require five to 10 cases before trust and comfort with the technique exists. The Medacta Efficiency instrumen- tation performs remarkably similar to tra- ditional metal instrumentation and has an even shorter learning curve. The best way for a surgeon to learn the technique is to be methodical. A visit to a reference center to see the technology in another surgeon's hands followed by performing the procedure in a cadaver lab will provide the necessary tools for the surgeon to begin on their journey with the technique. CF: The incentive of using the equipment is the same, the learning curve has to do with the comfort level with the cutting guides, and it takes a while to get used to especially if you use the CT-produced cutting guides. I like the CT better because you're referenc- ing on bone instead of articular cartilage. To make this technique reproducible, one should shadow a surgeon to see how the cutting guides are anchored to the bone. Next, you can go to a lab and do the surgery on a cadaver.