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Reusable Instrumentation for Arthroscopic Rotator Cuff Repair May Not Impact Clinical Outcomes
Seyedeh Zahra Mousavi1, Prasenjit Saha, Steve S Li
1From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Ms. Mousavi, Dr. Saha, Dr. Li, Dr. Fox, Dr. Schmucker, and Dr. Srikumaran), and the Department of Orthopaedic Surgery, Riverside University Health Systems, Moreno Valley, CA (Dr. Haft).
Introduction:
Hospitals contribute to substantial environmental waste and greenhouse gas emissions, with operating rooms accounting for 50% to 70% of hospital waste. Arthroscopic rotator cuff repair (RCR), a commonly performed procedure, typically uses disposable instruments to minimize infection risk. There is limited evidence regarding the clinical safety and effectiveness of disposable instruments compared with reusable instruments. We aimed to evaluate whether reusable instrumentation for arthroscopic RCR affects clinical outcomes.
Methods:
This was a retrospective cohort study involving 191 patients undergoing primary arthroscopic RCR. Patients were divided into reusable (N = 89) and disposable (N = 102) instrumentation cohorts. Primary outcomes included rates of postoperative soft-tissue infection and septic revision within 1 year postoperatively. Data were analyzed using frequentist and Bayesian statistical methods.
Results:
Infection rates and septic revisions were similar between reusable and disposable instrumentation groups, with one septic revision in each cohort (P = 1.0). Aseptic revision rates were also similar (P = 0.50). Surgical times did not significantly differ between groups (reusable: 1.50 ± 0.33 hours; disposable: 1.61 ± 0.41 hours; P = 0.076). Bayesian analysis supported these findings, demonstrating no meaningful difference in infection risks between groups, with median odds ratios close to 1.0 and credible intervals including 1.0.
Conclusion:
Observed proportions of revision and infection were similar in magnitude. These findings suggest that reusable instruments have the potential to be a safe and sustainable alternative to single-use instruments in arthroscopic RCR. However, owing to the rarity of infection and revision, future multisite studies are necessary to assess whether risk of these outcomes is noninferior to nonreusable instruments.
