title: Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.
abstract: Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency.
authors.affiliation: Academic Training, Hospital for Special Surgery, New York, New York.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Kaitlin M
authors.initials: KM
authors.lastname: Carroll
authors.affiliation: Academic Training, Hospital for Special Surgery, New York, New York.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Blevins
authors.affiliation: Operational Excellence, Hospital for Special Surgery, New York, New York.
authors.forename: Scott T
authors.initials: ST
authors.lastname: DeNegre
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Mayman
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Jerabek
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000295:instrumentation*; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009873:Operating Rooms; D010865:Pilot Projects; D010934:Planning Techniques; D057285:Precision Medicine / Q000191:economics / Q000295:instrumentation*
keywords: decision modeling; digital radiography; knee replacement arthroplasty; organizational efficiency; template