Issue link: https://beckershealthcare.uberflip.com/i/827052
47 Executive Roundtable Q: Do these instruments facilitate per- formance of same-day TKA? Why? CF: Yes. What you're doing is eliminating a lot of the costs of sterilization, and not only from the physical cost of sterilization but the labor costs of getting trays ready; the time component of money and physical cost of sterilization as well. Additionally, there is no cost for storage of the equipment. There is a safety aspect in an outpatient facility where you want to minimize the risk, so a separate disposable tray is used for each patient. There is more risk of something being reused than brand new. TG: I have found MyKnee and Efficiency almost invaluable in my ambulatory sur- gery center to perform my outpatient TKAs. Our surgery center is not designed to sterilize the large, heavy instrumenta- tion sets required to perform these pro- cedures. Additionally, we do not have the space to store the sets for the surgery. Having pre-packaged, pre-sterilized in- strumentation available for these cases al- lows me to perform these procedures in this setting which I would otherwise not be able to. In addition, the weight of the sets cannot be overlooked. A traditional metal instrument set weighs 74.5 lbs. In contrast, the equivalent MyKnee, Efficiency weighs 5.5 lbs. — a delta of 69 lbs.! This cannot be overlooked in an ASC setting where light, nimble equipment facilitates the day. Q: Would you recommend the instru- ments for their accuracy and efficiency? CF: Yes, very rarely do I have to make a re-cut. Sometimes in patients who have significant varus deformity, I will not use the custom cutting guide; I will use the standard varus-valgus cutting block and not cut as much varus. However, I use the custom cutting guide to mount the pins and then place the standard valgus/varus cutting guide on the pins. I've never had to re-cut a femur, but have had to re-cut a tibia a few times. TG: I routinely recommend the technique for both accuracy and efficiency. From my own personal data, I actually improved my alignment with this technique com- pared to my previous computer-assisted orthopedic surgery experience. My align- ment results for my MyKnee patient- matched procedures were 94 percent compared to 92 percent with computer- assisted orthopedic surgery. My efficiency with my procedures has come not from my own operative times, but from room set-up and turnover times at the end of the case. Recently, we performed a study in which we timed the opening and closing of a room for a TKA procedure utilizing both Efficiency and standard instrumentation. We found a savings of 15 minutes in set-up and 10 minutes in take-down per case — a significant savings of 25 minutes per case! Q: How many procedures have you performed with the platform? TG: I began using the MyKnee platform in April 2010. Unbelievably, I have not changed from this technique in seven years. I perform roughly 300 TKAs per year, totaling about 2,000 cases. I began using the Efficiency single-use instru- ments in May 2013. My first experience was sporadic due to the prototype nature of the initial instruments. Steadily, as pro- duction has improved and increased so has my use of the instruments. I currently use Efficiency instruments in approximately 50 percent of my cases totaling over 500 cases in the last four years. As stated previously, my comfort with the instruments has grown to now I consider them my "standard." CF: I've performed probably a little over 100 procedures with the MyKnee Effi- ciency platform. There is a learning curve getting used to removing the articular cartilage to anchor the feet on the cut- ting guides. Now, I can do this almost as quickly as my previous technique. It can be done off an MRI as well. The instru- ments are well thought out with some things having multiple uses to limit the number of pieces and operative steps. Q: Have your patients expressed satisfaction with the GMK Sphere TKA system? Would you say the implant system's inherent stability lends to accelerated postoperative ambulation and discharge? CF: So far the patients have been happy. I've found that they don't seem to swell as much. With the Medacta system, you don't have to enter the canal of the dis- tal femur and so there's less swelling and they rehab faster. You can see the tibia ro- tating with the trials mimicking a human knee more naturally. TG: My heritage for TKA has been to use a PCL substituting "deep dish" implant. As such, I have always been comfortable with releasing the PCL and relying on the de- sign of the implant for the kinematics of the knee. What I noticed very quickly after be- ginning with the GMK Sphere system was that my patients who would have done well with the deep dish, did exceptionally well with the Sphere. Their range of motion was greater to a point where I noticed patients would routinely kneel and squat, some- thing I did not have before. I did not change my technique, but only my implant to achieve these results. I believe this is a testament to the inherent stability of the knee. I also believe patients experience less mid-flexion instability with the Sphere and consequently are able to navigate stairs and low-seated chairs more confidently. I believe these early outcomes derive more from good perioperative protocols for pain control, mobilization and patient education. I routinely perform TKA on an outpatient basis, which is more of victory for my peri- operative care than for the actual implant. Q: Have you found a financial advan- tage in using the products together? By leveraging the platform, have you also seen reductions in OR time, room turnover time and processing costs? TG: We recently looked at 100 cases us- ing the MyKnee Efficiency technique versus traditional technique utilizing a Sphere implant. We accounted for sev- eral variables to model the potential eco- nomic benefit including: 1. Reduced infection risk 2. Operating room time efficiencies 3. Absence of use of the Central Steril- izing Department 4. Loaner tray utilization 5. Cost of the products Our economic modeling projected a $1,189.10 per case savings when using the MyKnee Efficiency products. As stated pre- viously, we further found a 25 minute per case improvement in case time. Addition- ally, the Efficiency instruments come pre- sterilized so the CSD is eliminated, which accounted for $700 per case considering the time and number of trays processed. CF: Yes, [I've seen] some direct and some indirect cost savings. I think at first you're not going to see reduction in OR time because of the learning curve. Now, I'm doing the procedure as fast as my previ- ous technique and there is little turnover time because there are no trays to clean up other than a general instrument tray; the rest is disposable. n Medacta® International is a world leading manufacturer of orthopedic implants, neurosurgical systems, and instrumentation. Medacta's revolution- ary approach and responsible innovation have resulted in standard of care breakthroughs in hip replacement with the AMIS® system and total knee replacement with MyKnee® patient matched technology. Over the last 10 years, Medacta has grown dramatically by taking a different approach and placing value on all aspects of the care experience from design to training to sustainability. Medacta is headquartered in Castel San Pietro, Switzer- land, and operates in over 30 countries. To learn more about Medacta International, please visit www.medacta.com or follow @Medacta on Twitter.