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Review paper

Single use instruments for total knee arthroplasty

By
Michele Romeo Orcid logo ,
Michele Romeo
Contact Michele Romeo

Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy

Giuseppe Rovere ,
Giuseppe Rovere

Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy

Leonardo Stramazzo ,
Leonardo Stramazzo
Contact Leonardo Stramazzo

Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy

Francesco Liuzza ,
Francesco Liuzza

Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy

Luigi Meccariello ,
Luigi Meccariello

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Giulio Maccauro ,
Giulio Maccauro

Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy

Lawrence Camarda
Lawrence Camarda

Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy

Abstract

Aim
Total knee arthroplasty represents a procedure that is successfully performed to relieve functional limitation and pain in advanced stages of osteoarthritis. In the next 20 years the number of these procedures will be increased about four times. Patient specific instrumentation (PSI) has been introduced in the past years. The aim of this study was to evaluate whether SUI are more useful in clinical, organizational and economic terms.
Methods
A database search about single use instrumentation (SUI) was conducted on PubMed and Google Scholar for the period 2010-2020 using the following key “total knee replacement”, “total knee arthroplasty”, “single use instruments”, and “disposable instruments”. The results of the selected studies were classified according to clinical, economic and organizational criteria.
Results
The main advantage of SUI has been reported to reduce costs, timely turnover of operating rooms, maximizing the operating room utilization and patient throughput, improving the number of outpatient total joint replacements. No difference has been found other than with regard to conventional instruments in terms of clinical outcome such as hip-knee-ankle angle and other radiographic parameters, Oxford Knee Score, while a decreased infection rate has been demonstrated. Regarding the economic aspect, a reduction of direct and indirect reduction of costs has been shown
for the cost of instruments reprocessing, tray sterilization, 90-day infection rate.
Conclusion
The SUI can be an alternative to conventional instruments, but there are still few studies in the literature regarding clinical outcomes.

References

1.
Singh J, Yu S, Chen L, Cleveland J. Rates of total joint replacement in the united states: future projections to 2020-2040 using the National Inpatient Sample. J Rheumatol. 2019. p. 1134–40.
2.
Bonutti P, Zywiel M, Johnson A, Mont M. The use of disposable cutting blocks and trials for primary total knee arthroplasty. Tecn Knee Surg. 2010. p. 249–55.
3.
Camarda L, ’arienzo D, Morello A, Peri S, Valentino G, B, et al. Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg. 2015. p. 11–8.
4.
Bert J, Hooper J, Moen S. Outpatient total joint arthroplasty. Curr Rev Musculoskelet Med. 2017. p. 567–74.
5.
Abane L, Zaoui A, Anract P, Lefevre N, Herman S, Hamadouche M. Can a single-use and patient-specific instrumentation be reliably used in primary total knee arthroplasty? A multicenter controlled study. J Arthroplasty. 2018. p. 2111–8.
6.
Attard A, Tawy G, Simons M, Riches P, Rowe P, Biant L. Health costs and efficiencies of patientspecific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial. BMJ Open Qual. 2019. p. 493.
7.
Bugbee W, Kolessar D, Davidson J, Gibbon A, Lesko J, Cosgrove K. Single use instruments for implanting a contemporary total knee arthroplasty system are accurate, efficient, and safe. J Arthroplasty. 2020. p. 30782–8.
8.
Siegel G, Patel N, Milshteyn M, Buzas D, Lombardo D, Morawa L. Cost analysis and surgical site infection rates in total knee arthroplasty comparing traditional vs. single-use instrumentation. J Arthroplasty. 2015. p. 2271–4.
9.
Goldberg T, Seaveyet R, Kuse K, Domyahn M, Torres A. Value in single use instruments for total knee arthroplasty: patient outcomes and operating room efficiency. 2017.
10.
Decook C. Outpatient joint arthroplasty: transitioning to the Ambulatory Surgery Center. J Arthroplasty. 2019. p. 48–50.
11.
Cendan J, Good M. Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload. Arch Surg. 2006. p. 65-e69.
12.
Dexter F, Abouleish A, Epstein R, Whitten C, Lubarsky D. Use of operating room information system data to predict the impact of reducing turnover times on staffing costs. Anesth Analg. 2003. p. 1119–26.
13.
Cichos K, Hyde Z, Mabry S, Ghanem E, Brabston E, Hayes L, et al. Optimization of orthopedic surgical instrument trays: lean principles to reduce fixed operating room expenses. J Arthroplasty. 2019. p. 2834–40.
14.
Mont M, Mcelroy M, Johnson A, Pivec R. Single-Use Multicenter Trial Group Writing Group. Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases. J Arthroplasty. 2013. p. 1135–40.
15.
Goldberg T, Maltry J, Ahuja M, Inzana J. Logistical and Economic Advantages of sterile-packed, single-use instruments for total knee arthroplasty. J Arthroplasty. 2019. p. 1876–83.
16.
Haddad F, Ngu A, Negus J. Prosthetic joint infections and cost analysis? Adv Exp Med Biol. 2017. p. 93–100.
17.
Kapadia B, Mcelroy M, Issa K, Johnson A, Bozic K, Mont M. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty. 2014. p. 929–32.
18.
Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of surgical site infections associated with arthroplasty and the contribution of Staphylococcus aureus. Surg Infect. 2016. p. 78–88.
19.
Dancer S, Stewart M, Coulombe C, Gregori A, Virdi M. Surgical site infections linked to contaminated surgical instruments. J Hosp Infect. 2012. p. 231–8.
20.
Mobley K. Jackson JB 3rd. A prospective analysis of clinical detection of defective wrapping by operating room staff. Am J Infect Control. 2018. p. 837–9.
21.
Waked W, Simpson A, Miller C, Magit D. Grauer JN. Sterilization wrap inspections do not adequately evaluate instrument sterility. Clin Orthop Relat Res. 2007.

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