The Reduction of Implant-Related Errors and Waste in Total Knee Arthroplasty Using a Novel, Computer Based, e.Label and Compatibility System Michael P. Ast, MD, David J. Mayman, MD, Edwin P. Su, MD, Alejandro M. Gonzalez Della Valle, MD, Michael L. Parks, MD, Steven B. Haas, MD, MPH Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York abstract article info Article history: Received 14 February 2013 Accepted 18 March 2013 Keywords: total knee arthroplasty wasted implants implant related errors Implant related errors and wasted arthroplasty implants represent a significant problem in the healthcare system. Studies estimate that an implant is wasted in two to five percent of total joint replacement procedures. After the introduction of a standardized time-out procedure, our institution still had a wasted implant in one out of every 20 arthroplasty surgeries. We then implemented a computer based, e.Label and compatibility system which standardized the implant labeling, confirmed correct size and side, and ensured compatibility within implant systems. Use of this system decreased wasted implants from 5.7% to 0.8% of total knee arthroplasty cases. This translated to an annualized cost savings of over $75,000 over our study period which could extrapolate to over $82 million per year in savings to the US healthcare system. © 2014 Elsevier Inc. All rights reserved. Implant related errors are a commonly encountered problem in orthopaedic surgery [1]. In addition to discarding sterile implants, and the associated costs, these errors may lead to patient harm. Wasted implants in arthroplasty surgery increase the cost of care on both hospitals and the overall healthcare system [2]. In our institution, dedicated exclusively to the delivery of musculoskeletal care, a sterilely packaged implant that is opened and not implanted is wasted in one out of every 20 primary total knee replacement procedures. The cost of wasted implants is most often absorbed by the hospital and represents a substantial waste of healthcare spending. In our institution, it is estimated that the cost of these wasted implants exceeds $1 million per year. The reasons why implants are opened but not implanted during arthroplasty surgery include contamination or damage by a member of the surgical team, unforeseen surgical issues that arise during implantation requiring a change in the necessary implant, such as an intra-operative fracture or the need for additional constraint, as well as opening of an incompatible combination of implants. The latter can include implants of the wrong size or wrong side, implants of different knee designs from the same manufacturer, or implants of different manufacturers. These issues can be compounded by the complex compatibility issues within modern arthroplasty systems and diffi- culty visualizing and interpreting implant labels. There is little room to prevent contaminated, dropped, or broken implants, or to avoid all intra-operative issues. In order to decrease the waste caused by compatibility issues, our institution implemented a systematic implant “time-out” to verify laterality, size, design and manufacturer. Despite this system, wasted implants still occur in more than 5% of cases. We propose the introduction of a novel, computer based, e.Label and compatibility system to reduce implant-related medical errors and waste in total knee arthroplasty. We hypothesize that the implementation of this system will help reduce medical errors and wasted implants by improving and standardizing the visual markers for both the surgeon and operating staff, and also by ensuring that all parts are compatible so that implant mismatches and inappropriate laterality are prevented. Methods and Materials Prior to the initiation of this study, our institution recognized the danger of implant errors as well as the importance of wasted implants. A “time-out” procedure had been implemented to stop the surgical procedure and to ensure that all implants were inspected by the entire operating room staff, including the operating surgeon, prior to opening of the boxes. A 32 inch flat panel monitor was installed in each operating room and connected to a video camera that was used to project the box labels onto the screen (Fig. 1) for visual inspection by all members of the surgical team. A standardized protocol was put in place which encompassed an eight point checklist prior to opening any package. The checklist included confirmation of the manufacturer, implant system, size, laterality, metal compatibility and expiration The Journal of Arthroplasty 29 (2014) 132–136 The Conflict of Interest statement associated with this article can be found at http:// dx.doi.org/10.1016/j.arth.2013.03.013. Reprint requests: Michael P. Ast, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021. 0883-5403/2901-0027$36.00/0 – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.arth.2013.03.013 Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org