Optimizing surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement

Kota Watanabe ¹, Takuji Iwamoto ¹, Robert Nakayama ¹

⁰Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association +

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May 8, 2025

View abstract on PubMed

Summary

Optimizing surgical instrument trays in orthopedic surgery reduces waste and costs. Lean methodology improved tray utilization and saved money without impacting surgery times.

Area Of Science

Orthopedic Surgery
Hospital Operations Management
Lean Methodology

Background

Operating rooms (ORs) are resource-intensive, with overstocked instrument trays increasing costs and inefficiencies.
Instrument tray optimization is critical for cost reduction but has been under-addressed in orthopedic surgery.

Purpose Of The Study

To analyze surgical instrument and implant utilization in orthopedic procedures.
To implement and assess Lean methodology for optimizing surgical trays and reducing costs.

Main Methods

Prospective observational study of total knee arthroplasty (TKA), total hip arthroplasty (THA), anterior cruciate ligament (ACL) reconstruction, and posterior spinal fusion (PSF).
Applied Lean methodology to identify and remove unnecessary instruments and implants.
Compared instrument utilization, sterilization costs, and OR preparation times pre- and post-optimization.

Main Results

Pre-optimization utilization rates were low (58-65% instruments, 5-11% implants).
Post-optimization saw reduced tray/implant numbers and improved utilization (PSF: 67%, THA: 75%, ACL: 67%).
Cost savings of up to 1374 JPY per case and estimated annual savings of 729,575 JPY were achieved; intraoperative times remained largely unchanged.

Conclusions

Lean-based optimization effectively reduces material waste and sterilization costs in orthopedic surgery.
Optimization achieved significant cost savings without compromising surgical efficiency.
Further research is recommended for long-term impact and standardization in orthopedic procedures.

Keywords:

Cost reduction Instrument tray optimization Lean methodology Orthopedic surgery Sterilization cost