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The fact that increasing numbers of joint replacement cases are moving to ASCs barely registers on the buzz meter. What’s perhaps more interesting to consider is that more same-day procedures are being done in hospitals.
“Hospital outpatient departments are physical assets, and as ASCs become more popular, hospitals are adapting to operate with similar expectations for efficiency,” said Tim Czartoski, President of U.S. Surgical and Global Product and Enabling Technologies at Enovis. “The migration of cases is impacting both settings.”
Surgeons now shift their procedures between hospitals and ASCs, which levels up the service requirements for OEMs that must support their customers in multiple locations.
“That means supplying instruments and implants efficiently — only what’s needed and only when it’s needed — while working within the realities of limited storage space, cost pressures and the need for small equipment footprints,” Czartoski said.
Surgeons want access to tools that help them perform surgery efficiently and effectively, whether that involves precise anatomic or kinematic alignment in the knee or improved glenoid placement in the shoulder. The challenge for OEMs, according to Czartoski, is to design simplified and efficient systems that also improve surgical performance.
That’s why Enovis is focused on developing one- or two-tray instrumentation systems and combining them with enabling technology platforms that are built specifically for smaller, space-limited environments — whether that’s in a hospital or ASC.
Smart instrument set design has become a competitive differentiator for OEMs because surgical facilities and surgeon customers are facing declining reimbursements and increasing pressure to reduce O.R. time, instrument reprocessing costs, and waste. Sterile processing capacity and storage limitations are now major bottlenecks, so systems that reduce tray volume provide immediate operational relief.
“Data shows that up to 78% of instruments in traditional trays go unused, making streamlined sets a clear value opportunity,” Czartoski said. “Facilities are also evaluating implant systems based not only on clinical outcomes, but on total cost of care, including inventory management, sterilization workload and turnover impact.
“Companies that address these efficiency constraints gain a compelling value-based advantage in an increasingly price-sensitive market.”
A significant portion of hip and knee procedures are performed in ASCs, and a major share of shoulders are split between ASCs and hospitals. The takeaway is simple, according to Czartoski.
“Efficiency isn’t just for the ASC. Hospitals need it just as much, and industry needs to provide solutions that provide it in both settings,” he said. “We continue to iterate on ways to make procedures easier, more cost effective and capable of supporting advanced surgical techniques, regardless of where they’re performed.”
Doing More with Less
The Klassic ONE System from Total Joint Orthopedics (TJO) aligns with the shift toward outpatient and ASC environments by enabling up to 90% of total knee cases to be performed with a single tray of instruments.
“It reduces turnover time and setup complexity, supporting additional daily case capacity and enhancing ASC profitability,” said Scott Emami, Vice President of Marketing at TJO.
According to Emami, an ASC that performs 500 joint replacements in a year will average $650,000 in annual savings. He also provided additional compelling cost- and time-saving data associated with Klassic One.
Studies show annual savings of $150,000 to $250,000, driven by reductions in sterilization, storage and turnover time, with each eliminated tray saving approximately $60 to $150 per sterilization cycle. O.R. setup time has been reduced by 15 to 20 minutes per case.
Inventory footprint is minimized through TJO’s universal femur component, which eliminates the need for facilities to store left and right knee-specific SKUs. It also supports consistent workflows for non-dedicated O.R. teams, improving reliability and shortening training time.
By accelerating room readiness with standard instrumentation and eliminating peel packs and the need for advanced imaging, as well as decreasing the sterile processing workload, Klassic ONE addresses major operational challenges for high-volume outpatient facilities.
It also solves issues surrounding instrument redundancy and “just-in-case” tools that are rarely used, sterile processing bottlenecks and workflow inconsistency caused by multiple tray configurations or size-specific instrumentation.
“There was also a need for a universal implant platform that offers a full range of sizes and stability options without increasing the instrumentation burden,” Emami said.
Klassic ONE features universal femoral and tibial components that allow one femur and one tibia to fit the left or right knee, eliminating left/right duplication. The components were the system’s biggest engineering challenge — and its biggest innovation.
Emami said legacy symmetric and universal designs had a highly constrained trochlea that went straight up the femur without a double Q-angle. They also had short and thick anterior flanges, which lead to the patella riding off the top of the trochlea and overstuffing the patella/femoral joint.
“Our patented nine-degree double Q-angle was designed to allow the patella to track where the native soft tissues drive it, regardless of joint laterality,” Emami said. “The lateral and medial prominences of the double Q-angle trochlea support the patella from subluxation, while the less constrained center of the trochlea allows free motion of the patella.”
TJO invested heavily in the design of multi-use instruments, such as a universal cut block and dual-purpose handles, to significantly reduce the required tray contents. According to Emami, Klassic ONE was developed using a holistic design approach in which implants, instruments and workflow were engineered together rather than retrofitted.
He explained that standardized connections and streamlined trials allow surgeons to transition between CR, UC, PS or constrained implant options without the need to open additional trays.
He also pointed out that Klassic ONE’s tray weights remain below the 25-lb. guideline issued by the Association of periOperative Registered Nurses, improving staff ergonomics and safety.
“Additionally, the smaller exposed instrument surface area helps lower contamination risk by decreasing exposure time,” Emami said.
Surgeons who operate with Klassic ONE report a faster, more predictable workflow with fewer steps and significantly fewer trays to manage. The universal cut block and multi-use instruments simplify transitions during the case and reduce cognitive load.
“The system’s streamlined instrumentation layout enhances efficiency and familiarity, especially for rotating surgical teams,” Emami said. “Plus, reduced clutter on the back table and around the sterile field improves focus, ergonomics and overall safety.”
Giving surgeons and surgical teams fewer instrumentation options ultimately helps them work smarter, not harder.
“Reducing the number of trays results in faster case starts, quicker O.R. turnovers and more reliable workflow efficiency,” Emami said.
