133. INTRA-OPERATIVE HIP AND KNEE ARTHROPLASTY IMPLANT WASTE: A POTENTIAL TARGET FOR COST CONTAINMENT EFFORTS

Abstract

Purpose: Many strategies have been reported for decreasing the cost of orthopaedic procedures, including negotiating lower prices with manufacturers and using lower-cost generic implants, but prosthetic waste has not been investigated. The purpose of this study was to characterize the present and potential future cost of intra-operative waste of hip and knee implants.

Method: A regional prospective assessment of implant waste was performed from January 2007 to June 2008, evaluating the incidence and reasons for component waste, the cost of the wasted implants, and where the cost was absorbed (hospital or manufacturer). Using published data on nationwide arthroplasty volumes, the results were extrapolated to the whole of the United States. Finally, based on peer-reviewed estimates of nationwide arthroplasty volumes for the next 20 years, a projection was made about the future cost burden of implant waste.

Results: Implant waste occurred in 79 of 3443 recorded procedures (2%), with the surgeon bearing primary responsibility in 73% of occurrences. The annualized waste cost was $109,295.35, with 67% absorbed by the hospital. When extrapolated to the whole of the United States, the annual cost to hospitals of hip and knee prosthetic waste is $36,019,000, and is estimated to rise to $112,033,000 in current dollars by the year 2030.

Conclusion: This study discovered a notable incidence of intra-operative hip and knee implant waste, with the majority of cases attributed to the surgeon, and representing an important additional cost burden on hospitals. With arthroplasty rates projected to increase markedly over the next twenty years, this waste represents a potentially noteworthy target for educational programs and other cost containment measures in orthopaedic surgery.