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.

Purpose: Minimally-invasive total knee arthroplasty has generated tremendous recent interest, but there have been reports of complications resulting from these new techniques. However, most studies have less than one year follow-up and are anecdotal in their results. The purpose of this study was to retrospectively evaluate a series of 1,000 consecutive minimally invasive total knee arthroplasties, to describe the clinical and radiographic complications of this technique, to determine whether complication rates changed with experience, and finally to compare complication rates to a match group operated by the same surgeon.

Method: Clinical and radiographic data were reviewed for the first 1,000 consecutive minimally-invasive knees (820 patients) performed by a single surgeon with a minimum 2 year post-operative period. All patients were operated using the mid-vastus approach, with a mean incision length of 10 cm (range, 8 to 13 cm). Nine patients were lost prior to 2 year follow-up, leaving 990 knees (811 patients) in this report with annual follow-up. After determining overall results, data was stratified into 100-knee groups to determine whether complication rates changed over time. Finally, complication rates were compared to a matched group of 50 knees operated by the same surgeon.

Results: There were a total of 45 clinical complications (4.5%), including 20 (2.0%) manipulations under anesthesia, 12 (1.2%) arthroscopies for painful crepitus, 4 (0.4%) component changes, and 3 (0.3%) spacer changes. There were 3 (0.3%) impending radiographic failures. Stratification of results showed a complication rate of 6% over the first 200 knees, and 1% over the subsequent 800 knees. In comparison, the matched group had a complication rate of 4% over mean follow-up of 3 years (range, 2 to 4).

Conclusion: This large series with minimum two year follow-up describes many of the long-term complications of this technique. Additionally, this large series suggests that high volume knee surgeons may require as many as 200 minimally invasive arthroplasties before achieving optimum proficiency with this technique. Nonetheless, comparison to a matched group suggests that even with this learning curve, complication rates need not increase markedly during this period if surgeons remain attentive to the potential complications associated with minimally invasive techniques.

Introduction: A number of surgical techniques have been described for the operative treatment of late stage osteochondritis dissecans (OCD) in the knee and ankle that have failed nonoperative management. However, no particular technique has been universally successful. We report the results of a new technique using retrograde drilling combined with the use of a novel collagen based bone void filler to prevent mechanical failure of the joint surface. The purpose of this study was to evaluate the results of this new technique and analyze the efficacy of both collagen Type-1 based osteoinductive bone void fillers Colloss and Colloss E with and without additional bone grafting.

Methods: The osteoinductive bone void fillers Colloss (bovine) and Colloss E (equine) are bone inducing collagenous sponges. The osteoinductive properties are due to the interactive release of BMP-2, BMP-7, IGF-1 and TGF-beta from the implant and the surrounding host tissue by osteoclastic and osteoblastic action. All surgeries performed in the present series included retrograde drilling procedures for OCD in the talar dome and the femoral condyles. Between 2000 and 2006 eight patients were treated by retrograde drilling or trephine drilling under arthroscopic and fluoroscopic control preventing injury to the cartilage surface. The subchondral cavity was filled with a mixture of 20–40 mg bone void filler and morsellized bone graft. The bone void filler is tamped through the drill guide and into position with a Steinmann pin. Thus, only the subchondral defect was filled but the peripheral area of the drill hole remained empty. Evaluation was achieved by clinical assessment, radiographic, and magnetic resonance imaging examination. The follow-up averaged 24 months up to 48 months.

Results: In all cases, osseous density increased in the Colloss filled subchondral area and mechanical impression of the joint surface could be prevented. Interestingly, clinical examination and follow-up MRI exams demonstrated moderate swelling and joint effusion in 5 of 8 cases for a period of 4 to 10 weeks postoperatively. This may be in part due to the augmentation technique. Nevertheless, good clinical (range of motion, pain) and radiographic results (bony healing) were obtained after this new treatment modality.

Discussion: The subchondral application of Colloss in OCD bone cysts or osteonecrosis induced solid osseous formation at the implantation site. The results of persisting joint reaction such as swelling, pain, and prolonged bone edema in MRI scans may be due to mechanical bearing indicating that augmentation of the defect has to be improved to ensure a solid bony reconstruction. Major advantages of this technique include the ease of performing this procedure, the one-step nature of the procedure, and the ability to avoid violation of stable articular cartilage. In addition, this technique may be repeated according to the size of the lesion.