The Rationalization of Surgical Trays in Staged Bilateral Lower Limb Arthroplasty: A 10-Year Cohort Study

Background Surgical tray rationalization involves minimizing surgical equipment to reduce operating theater expenses. This study aims to assess whether rationalization of surgical trays is possible in a staged bilateral total hip or total knee replacement by utilizing the first surgical tray as a reference. Methodology A retrospective analysis was conducted of a consecutive cohort of staged bilateral lower limb arthroplasties from August 2009 to February 2020. The staged procedures were performed by the same surgeon using the same technique and the same implant system between the sides. Results A total of 442 out of 511 consecutive staged lower limb arthroplasties were included. For bilateral total knee replacements (BTKRs), 146 joints were operated on in 73 patients. The mean interval between sides was 28 months. Overall, 72/73 (98.6%) patients had both tibial and femoral components that were within one size of the first side operated on. For bilateral total hip replacements (BTHRs), 296 joints were operated on in 148 patients. The time interval between sides was 24 months. Overall, 140/148 (94.6%) patients had an acetabular cup size that was within a one-size difference between the first and second-side surgery. Regarding differences in femoral stem sizes, 130/148 (87.8%) had an implant that was again within a one-size difference between the first and second-side surgery. Our results demonstrated that the rationalization of surgical trays can be adopted for patients who have implants that are within one size of the first side operated on in both BTKRs and BTHRs. This has the potential to reduce costs by £159.81 and £151.26 per case, respectively. Conclusions This cohort study confirms implant sizes used for first-side surgery are a reliable predictor for those used in second-side surgery in staged bilateral lower limb arthroplasty. Used in conjunction with preoperative templating, the surgical team can confidently rationalize surgical trays, thereby improving theater efficiency and decreasing sterilization costs.