J Knee Surg 2013; 26(04): 285-290
DOI: 10.1055/s-0033-1333664
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Single-Use Instrumentation, Cutting Blocks, and Trials Decrease Contamination during Total Knee Arthroplasty: A Prospective Comparison of Navigated and Nonnavigated Cases

Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Aaron J. Johnson
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Kimona Issa
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Robert Pivec
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Kurt E. Blasser
2   Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
David McQueen
3   Department of Orthopedic Surgery, Kansas University, Kansas City, Kansas
Lalit Puri
4   Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
Daniel A. Dethmers
5   Department of Orthopedic Surgery, Bonutti Orthopedic Services, LTD, Effingham, Illinois
David W. Miller
6   Department of Orthopedic Surgery, West End Orthopedic Clinic, Richmond, Virginia
Philip H. Ireland
7   Department of Orthopedic Surgery, Indiana University, Fishers, Indiana
John R. Shurman
8   Department of Orthopedic Surgery, University of Kansas Wichita, Wichita, Kansas
Petter Bonutti
5   Department of Orthopedic Surgery, Bonutti Orthopedic Services, LTD, Effingham, Illinois
› Author Affiliations
Further Information

Publication History

10 July 2012

08 November 2012

Publication Date:
28 January 2013 (online)


The purpose of this prospective controlled trial was to determine whether decrease in contamination could be achieved in nonnavigated and navigated total knee arthroplasties by replacing traditional saws, cutting blocks, and trials with specialized saws and single-use cutting blocks and trials. Various tray wrapping metrics during total knee arthroplasty were measured in 400 procedures performed by 8 different surgeons at 6 institutions. Instrumentation contamination was determined by counting the number of tray sterility indicators, pans, and instruments that were compromised. The results show that a decrease in contamination was evident in 57% (nonnavigated) and 32% (navigated) fewer compromises of tray sterility indicators, pans, and instruments. Single-use instruments show promising benefits, but further study is needed to confirm safety and efficacy before they can be widely adopted. The authors believe that the use of single-use instruments, cutting guides, and trial implants for total knee arthroplasty will play an increasing role in decreasing operating room contamination and potential deep infections.

  • References

  • 1 Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA. Clin Orthop Relat Res 2012; 470 (1) 130-137
  • 2 Willis-Owen CA, Konyves A, Martin DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010; 92 (8) 1128-1133
  • 3 Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Rüden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008; 248 (5) 695-700
  • 4 Hooper GJ, Rothwell AG, Frampton C, Wyatt MC. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement? The ten-year results of the New Zealand Joint Registry. J Bone Joint Surg Br 2011; 93 (1) 85-90
  • 5 Pasquarella C, Pitzurra O, Herren T, Poletti L, Savino A. Lack of influence of body exhaust gowns on aerobic bacterial surface counts in a mixed-ventilation operating theatre. A study of 62 hip arthroplasties. J Hosp Infect 2003; 54 (1) 2-9
  • 6 Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 1999; 81 (10) 1434-1445
  • 7 Bonutti PM, Zywiel MG, Johnson AJ, Mont MA. The use of disposable cutting blocks and trials for primary total knee arthroplasty. Tech Knee Surg 2010; 9 (4) 249-255
  • 8 Waked WR, Simpson AK, Miller CP, Magit DP, Grauer JN. Sterilization wrap inspections do not adequately evaluate instrument sterility. Clin Orthop Relat Res 2007; 462: 207-211
  • 9 Galinski M, Catineau J, Rayeh F , et al. Laryngoscope plastic blades in scheduled general anesthesia patients: a comparative randomized study. J Clin Anesth 2011; 23 (2) 107-112
  • 10 Gupta A, Mercieca K, Fahad B, Biswas S. The effectiveness and safety of single-use disposable instruments in cataract surgery—a clinical study using a surgeon-based survey. J Perioper Pract 2009; 19 (4) 148-151
  • 11 Paolucci V, Schaeff B, Gutt C, Morawe G, Encke A. [Disposable versus reusable instruments in laparoscopic surgery—a controlled study]. Zentralbl Chir 1995; 120 (1) 47-52
  • 12 Scutt S, Clark N, Cook TM , et al. Evaluation of a single-use intubating videoscope (Ambu aScope™) in three airway training manikins for oral intubation, nasal intubation and intubation via three supraglottic airway devices. Anaesthesia 2011; 66 (4) 293-299
  • 13 Villamizar N, Pryor AD. SPIDER and flexible laparoscopy: the next frontier in abdominal surgery. Surg Technol Int 2010; 20: 53-58
  • 14 Fitz W. Unicompartmental knee arthroplasty with use of novel patient-specific resurfacing implants and personalized jigs. J Bone Joint Surg Am 2009; 91 (Suppl. 01) 69-76
  • 15 Hafez MA, Chelule KL, Seedhom BB, Sherman KP. Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res 2006; 444: 184-192
  • 16 Harrysson OL, Hosni YA, Nayfeh JF. Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study. BMC Musculoskelet Disord 2007; 8: 91
  • 17 Lombardi AV, Berend KR, Adams JB. Patient-specific approach in total knee arthroplasty. Ortho Super site. June 2012. Available at: http://www.orthosupersite.com/print/aspx?rid=31419
  • 18 Slover JD, Rubash HE, Malchau H, Bosco JA. Cost-effectiveness analysis of custom total knee cutting blocks. J Arthroplasty 2012; 27 (2) 180-185
  • 19 Sanzén L, Carlsson AS, Walder M. Air contamination during total hip arthroplasty in an ultraclean air enclosure using different types of staff clothing. J Arthroplasty 1990; 5 (2) 127-130
  • 20 Blom A, Estela C, Bowker K, MacGowan A, Hardy JR. The passage of bacteria through surgical drapes. Ann R Coll Surg Engl 2000; 82 (6) 405-407
  • 21 Brown AR, Taylor GJ, Gregg PJ. Air contamination during skin preparation and draping in joint replacement surgery. J Bone Joint Surg Br 1996; 78 (1) 92-94