Disposable Ancillary in Orthopedic Surgery: A Reliable Option Suitable for THA with Dual Mobility Cup
R Lecointre | JL Prudhon
Seance of wednesday 03 october 2018 (Évolution de l’orthopédie au 21e siècle – les jeunes orthopédistes)
DOI number : 10.26299/rb7d-kd42/emem.2018.2.002
Abstract
For biological safety reasons, the cutting tools used in bone surgery are now destroyed after each intervention. However, the evolution towards totally disposable surgical instruments is still slow, hampered by habits, the fear of a lack of precision or efficiency and, above all, by cost. We report the results of a preliminary study of a single-use instrumentation for the placement of dual-mobility cups in total hip arthroplasties (THA), to rationalize the potential economic benefits and gains.
Individual single-use kits, unlike traditional instrumentation, reduce the expense and time required to provide the ancillaries and sterilize them while improving their traceability and supply logistics. They make it possible to lighten the material, to reduce the size of the instrument tables, to limit the use to the only size necessary for the patient and to ensure a more important anti infectious safety. Finally, if single-use equipment increases the volume of cardboard and plastic waste, it makes it possible to reduce the transport of instruments and to significantly reduce the number of washes and sterilizations allowing a substantial saving of water. However, they require more storage space and are more expensive to manufacture.
The QUATTRO® dual-mobility cup disposable kit allows to measure the diameter of the femoral head, control the sphericity and the pressfit of acetabular reaming, place the final implant and perform the length tests on the femoral stem. A trial of 50 consecutive cases, analyzed according to the methodological criteria of the French Society of Sterilization Sciences confirmed the simplicity of use of this kit (3 size measurement errors at the start of the experiment, 2 cases with recourse to the standard instrument), without any complications. The gain in handling in the room was 10 kg, the saving in preparation and storage time of the instrumentation table by 4 and 2 minutes. In cost accounting, the total savings for a THA was € 35.55 (sterilization including maintenance, staff, equipment, water and electricity and staff time in the operating room). The environmental gain is linked to the lack of transport (3 kg CO2 eq for 35 km) and the saving of 1000 liters of water after 4 THA.
The disposable instrument for a THA saves time and handling, the safety of equipment that is always new, the permanent availability of the material without defect in supply, sterilization validated industrially and finally total and optimal traceability. It is part of a surgical, economic, regulatory and environmental logic. The addition of single-use reamers will further improve these productivity gains.
Individual single-use kits, unlike traditional instrumentation, reduce the expense and time required to provide the ancillaries and sterilize them while improving their traceability and supply logistics. They make it possible to lighten the material, to reduce the size of the instrument tables, to limit the use to the only size necessary for the patient and to ensure a more important anti infectious safety. Finally, if single-use equipment increases the volume of cardboard and plastic waste, it makes it possible to reduce the transport of instruments and to significantly reduce the number of washes and sterilizations allowing a substantial saving of water. However, they require more storage space and are more expensive to manufacture.
The QUATTRO® dual-mobility cup disposable kit allows to measure the diameter of the femoral head, control the sphericity and the pressfit of acetabular reaming, place the final implant and perform the length tests on the femoral stem. A trial of 50 consecutive cases, analyzed according to the methodological criteria of the French Society of Sterilization Sciences confirmed the simplicity of use of this kit (3 size measurement errors at the start of the experiment, 2 cases with recourse to the standard instrument), without any complications. The gain in handling in the room was 10 kg, the saving in preparation and storage time of the instrumentation table by 4 and 2 minutes. In cost accounting, the total savings for a THA was € 35.55 (sterilization including maintenance, staff, equipment, water and electricity and staff time in the operating room). The environmental gain is linked to the lack of transport (3 kg CO2 eq for 35 km) and the saving of 1000 liters of water after 4 THA.
The disposable instrument for a THA saves time and handling, the safety of equipment that is always new, the permanent availability of the material without defect in supply, sterilization validated industrially and finally total and optimal traceability. It is part of a surgical, economic, regulatory and environmental logic. The addition of single-use reamers will further improve these productivity gains.