scholarly journals Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial

2019 ◽  
Vol 8 (2) ◽  
pp. e000493 ◽  
Author(s):  
Andre Attard ◽  
Gwenllian Fflur Tawy ◽  
Michiel Simons ◽  
Philip Riches ◽  
Philip Rowe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Healthcare Provider ◽  
Operating Room ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Potential Cost ◽  
Time Intervals ◽  
Total Knee ◽  
Single Use

AimTo investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).Patients and methodsPatients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience.ResultsPSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.ConclusionsPSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.

Use of patient-specific cutting blocks reduces blood loss after total knee arthroplasty

2016 ◽  
Vol 27 (2) ◽  
pp. 273-277 ◽  
Author(s):  
Vicente J. León ◽  
María A. Lengua ◽  
Víctor Calvo ◽  
Alonso J. Lisón
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Total Knee

scholarly journals Blood Loss in Total Knee Arthroplasty

2016 ◽  
Vol 30 (05) ◽  
pp. 452-459 ◽  
Author(s):  
William Cundy ◽  
Annika Theodoulou ◽  
Chi Ling ◽  
Jeganath Krishnan ◽  
Christopher Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Computer Assisted ◽  
Routine Practice ◽  
Patient Specific Instrumentation ◽  
Transfusion Requirements ◽  
Total Knee

AbstractPatients undergoing total knee arthroplasty (TKA) have expected blood loss during and after surgery. The morbidity associated with blood loss and the burden of blood transfusions in adult arthroplasty necessitates preoperative optimization as routine practice. Current literature remains inconclusive on which TKA surgical instrumentation techniques are effective in minimizing perioperative blood loss, and consequently lower transfusion rates. The primary objective of this retrospective review, of a prospective randomized cohort study, was to compare surgical and patient factors, and their influence on blood loss and transfusions rates, between one type of patient-specific instrumentation (PSI), navigated computer-assisted surgery (CAS), and conventional TKA surgical techniques.A cohort of 128 matched patients (38 PSI, 44 CAS, 46 conventional surgeries) were compared. Preoperative factors analyzed included; age, gender, body mass index, preoperative hemoglobin (Hb) (g/L), international normalized ratio, use of anticoagulants and comorbid bleeding diathesis. Maximal Hb drop and transfusion requirements were compared on day 1 to 3. Perioperative factors collected included: surgical time, tourniquet time, drain output, in situ drain time, order of tibia or femoral cut, and intraoperative loss from suction.The three groups did not differ on the preoperative patient demographics examined. The difference between preoperative Hb and the lowest postoperative Hb readings did not differ between study groups (p = 0.39).There are no statistically significant differences in blood loss when comparing PSI versus CAS versus conventional TKA. Although emerging evidence on PSI is encouraging, the PSI technique for TKA does not result in reduced blood loss. The study was registered with ClinicalTrials.gov: NCT01145157.

scholarly journals Acute Perioperative Comparison of Patient-Specific Instrumentation versus Conventional Instrumentation Utilization during Bilateral Total Knee Arthroplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jerrod A. Steimle ◽  
Michael T. Groover ◽  
Brad A. Webb ◽  
Brian J. Ceccarelli
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Bilateral Total Knee Arthroplasty ◽  
Discharge Disposition ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition. A total of 49 patients with standard instrumentation and 31 patients with patient-specific instrumentation were retrospectively reviewed in a two-year period at one facility. At baseline, the groups were comparable with respect to age, ASA, BMI, and comorbid conditions. We analyzed data on operative time, blood loss, hemoglobin change, need for transfusion, pain medication use, length of stay, and discharge disposition. There was no statistically significant difference between groups in regards to these parameters. Patient-specific instrumentation in the setting of bilateral total knee arthroplasty did not provide any immediate perioperative benefit compared to conventional instrumentation.

The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty?

2014 ◽  
Vol 23 (7) ◽  
pp. 2055-2060 ◽  
Author(s):  
Emmanuel Thienpont ◽  
Irina Grosu ◽  
Frederic Paternostre ◽  
Pierre-Emmanuel Schwab ◽  
Jean Cyr Yombi
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Reduce Blood Loss ◽  
Patient Specific Instruments ◽  
Total Knee
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