Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

J Arthroplasty. 2019 Sep;34(9):1876-1883.e2. doi: 10.1016/j.arth.2019.03.011. Epub 2019 Apr 25.


Background: Total knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA.

Methods: Four variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique.

Results: The median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover.

Conclusion: This cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.

Keywords: efficiency and economic benefits; postdischarge complications; single-use instruments; sterilization; total knee arthroplasty.

Publication types

  • Comparative Study

MeSH terms

  • Arthroplasty, Replacement, Knee / economics
  • Arthroplasty, Replacement, Knee / instrumentation*
  • Cost Savings
  • Cost-Benefit Analysis
  • Humans
  • Models, Economic*
  • Operating Rooms / economics
  • Surgical Instruments / economics*