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Simplify to Succeed: Instrument Reduction in the OR

“First of all, what we have been focusing on in total knee replacement is reducing the number of trays used during a procedure: most of our competitors use around six or seven trays. Several years ago, we reduced that number to four with our U2™ Knee System, and now with our U2™ Knee All-in-One Block and Modular Disposable Trial, we can achieve the same results with just 1.5 trays.” he says. “By redefining our instruments and using more disposable trials, we were able to significantly reduce our instrumentation.”

A 2012 study found that during each total knee replacement procedure, a tray carrying 363 instruments was provided, while fewer than 50 of those instruments were routinely used. While that doesn’t mean that the instruments are unnecessary, it does raise the question of waste. Lin adds that he has seen reps manually reducing instruments for years, placing only needed instruments into the set. While the set may be heavy, it will also be far more efficient.

Echoing the sentiments of DJO and Premia Spine, Lin says that his company has noticed the increased weight of cost in decision making. He also cited the influence of bundled payments.

As UOC was looking through its portfolio of products, evaluating where it could make improvements, Lin’s team pinpointed the U2 Knee System, which has been on the market for a decade. Over the course of the last ten years, surgeon and distributor feedback was positive. However, the feedback also indicated the need for a new system.

Rather than trying to improve upon an implant that has an approximately 97% success rate, Lin’s team wanted to focus on instruments.

“We’re planning to launch our disposable trays in 3Q16 (as part of the U2 Knee System),” he says. “We want to see how surgeons respond. We think that this is a need, especially because of bundled payments. We believe cost and efficiency will be more important topics and want to take the lead as we move in that direction.”

The revised U2 Knee with fewer instruments works because UOC USA combined a femoral sizer with an AP cutting technique (All-In-One Block). The instrument reduces the surgical procedure by two steps. By wrapping several steps and instruments into one cutting block and utilizing the aforementioned disposable trays, UOC USA removed 156 instruments from the U2 Knee System.

Lin believes that changes in the marketplace will create opportunities for new partnerships between manufacturers and providers. Hospital systems that have longstanding relationships with certain OEMs may be incentivized to locate new, more efficient partners. By reducing trays, UOC USA thinks it can save hospitals money in a bevy of ways, including something as simple as tray processing, which can run as high as $50 to $100 per tray.

Meanwhile, many OEMs are behind the times. Lin says that he still sees companies bringing nine trays to a primary surgery, which he feels may not help the surgeon or the hospital staff save time in the OR.

“Surgeons will always want to do surgeries faster. Time is money. We work very closely with surgeons and OR staff to make sure our systems are easy to use,” Lin says. “It’s surprising how often overlooked simple enhancements to procedures can be – small changes, such as minimizing tray usage, can save hours of time and reduce cost long-term.”

According to research from American Academy of Orthopaedic Surgeons, more than 33% of the Amercian population has a musculoskeletal condition requiring medical attention. As the workload increases for orthopaedic surgeons, there is a greater need for effective surgery sets. Finding a way to reduce the burden that instrumentation can place on the system is a focus for much of the healthcare system.

Combating the cost associated with instrumentation in the OR has been front of mind for several OEMs. Companies like ConforMIS, Conventus, DePuy Synthes, Exactech, Flower Orthopedics and Zimmer Biomet have all recently launched instrument-reducing surgery sets.

Other companies will find alternate ways to reduce the cost of instrumentation. For instance, CrossRoads Extremity Systems launched their EcoSMART Program to combat excess in the OR and to create cost-savings for their customers. Instead of offering disposable instruments, the company is sticking with durables, but purchasing the instruments back from hospitals, reconditioning and repackaging them in new kits.

“By looking deeper, by finding ways to reduce the trays, we can save hospitals time and money,” Lin says. The companies that can respond to the challenges of their customers, and respond with an appropriate instrument reduction, helping their customers’ bottom line, will remain relevant in a pressured marketplace.

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Photo Courtesy of Caltorque Medical Products