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The buzz surrounding joint replacement advancements often focuses on personalized implants, advanced imaging solutions and surgical robots, but Goldilocks-inspired instrumentation trays — not too much, not too little — might make more of a practical difference to the surgeons and surgical team members who perform the procedures.
By tailoring trays to individual surgeons, their preferred workflows and the needs of specific patients, orthopedic companies are redefining the logistics and economics of joint replacement procedures.
Anand Bala, Vice President of Product Development at Maxx Orthopedics, recently discussed why interest in customized trays is growing and the benefits they bring, especially in ASCs that thrive on workflow efficiencies and space-saving solutions.
What critical customer needs are customized trays designed to address?
Take a typical ASC. To break even, they often need to run six to 10 surgeries a day in a single O.R. For a primary knee replacement, the average vendor brings in between five and eight trays of instrumentation. If you assume six cases and an average of six trays per case, that’s 36 trays that need to be reprocessed, along with all the consumables and disposables that come with them.
Most ASCs lack large autoclaves or high-capacity sterilization facilities, so processing dozens of trays becomes a massive burden on staff, space and time. At the end of the day, all of that translates directly into cost. Even if an autoclave can sterilize two or three trays per cycle, facilities run it constantly for long stretches and need people managing the flow of trays and instruments all day long.
Now imagine a different scenario: Instead of bringing 36 trays into the facility, a rep walks in with a single tray per case, plus one contingency tray on standby if it’s needed. That means a rep could bring in six or seven trays instead of 36. That shift alone dramatically reduces the strain on staff, capacity and sterilization equipment.
That’s the root need customized trays address. ASCs are facing shortages of staff, space and simply not enough time on the backend to keep up with the volume of surgeries that are moving to the outpatient setting.
What’s the best way to streamline instrument sets so only the necessary tools are included in trays?
Our Quick Recovery Solutions (QRS) One Tray is a focused pre-planning solution based on de-identified x-rays. Our team reviews the images and determines which sized instruments and implants the case will not require. We’re not trying to pinpoint the exact implant size. Instead, we identify which components are unnecessary. For example, if the case is a left knee, there’s no reason to bring right-sided femoral components. Yet without pre-planning, those extra parts are often needlessly carried into facilities.
And if you already know the patient is going to fall somewhere between a C- and a D-sized femoral component, the likelihood of needing something as large as a G or an H is essentially nonexistent. As long as a G or H set of instruments is available somewhere in the facility, it doesn’t need to be opened or placed on the back table in the O.R. The goal becomes eliminating what the case won’t require and bringing in only what has a high probability of being used.
Surgeons can electronically upload de-identified anteroposterior (AP) and lateral x-ray views of the knee, and we can turn around an assessment in as little as a day but typically within two to three days. That kind of planning removes a great deal of waste from the system and dramatically reduces the number of trays that need to be sterilized, handled and stored without compromising readiness in the O.R.
How important is factoring the preferences and surgical techniques of individual surgeons in the development of customized trays?
It’s essential. In joint replacement surgery, everything that’s required for a procedure is often bundled into an itemized bill of materials for the instrument tray. Little attention is given to a surgeon’s individual technique and whether the tray includes the specific instrument variations they prefer or whether it’s loaded with items they will never use. The mindset is essentially, “Here’s the standard set. You get everything possibly needed for a case, whether you use it or not.”
Our approach is different. We work to understand each surgeon’s actual workflow by giving them standard trays, then studying how they operate. Using video recordings of the back-table setup and instrument flow, we analyze usage patterns and surgical technique. Because instruments often come in multiple variations, we track which versions align with the way surgeons operate.
After observing around 10 surgeries, we can identify the surgeon’s true workflow: which instruments are essential, the ones that go consistently unused and tools that are needed only for contingencies. That understanding allows us to reduce a tray’s components down to the essentials, resulting in a configuration that’s customized to individual surgeons. Once the tray is designed, it’s reviewed and approved by the surgeon before being put into our system.
Our evaluation of x-rays ahead of surgery to estimate the likely instrumentation size range for a given patient lets us optimize what gets loaded into the tray. This modularity in sizing and in how components can be added or removed from tray designs allows us to create highly efficient patient- and surgeon-specific trays. It’s a core part of what makes our approach unique.
Importantly, we rely on multiple data points: both AP and lateral views must corroborate the sizing estimate, which adds a built-in safety check. After several years of doing this, we’ve developed substantial internal expertise and pattern recognition.
And as we continue working with a surgeon, the accuracy of our predictions improves through understanding which components were actually used and how close our estimates were. This ongoing feedback loop, combined with our experience and process rigor, is a major part of what differentiates us.
Surgeon philosophy also matters. For example, when a patient falls between femoral component sizes, does the surgeon tend to undersize or oversize? That preference becomes part of the understanding we build over time as we work with each surgeon and refine our predictions.
How do you demonstrate the cost benefits of customized trays to surgical facility leaders and surgeon customers?
We’re able to quantify our value in terms of an approximate per-instrument cost based on historical studies. The data show that QRS One Tray results in an estimated 61% to 69% reprocessing cost savings but honestly, most facility leaders don’t even need the math to understand the benefit. They’re used to companies showing up with five trays for a single surgery and leaving them to manage the reprocessing burden.
We deliver the components and instruments needed for an individual case with the least possible operational impact. There’s no heavy footprint, no overwhelming stack of trays and no logistical burden placed on the surgical team.
In an era with so much available technology, not taking advantage of tools that reduce this burden is a missed opportunity. For us, minimizing our footprint in the surgical center is a core internal driver. We see the opportunity clearly, and we’re committed to reducing the operational impact we have on every facility we serve.
