financial billing and coding data from 3,973 hip ( cpt 27130 ) , knee ( cpt 27447 ) , and shoulder ( cpt 23472 ) arthroplasties conducted at a physician owned orthopedic specialty hospital ( crystal clinic orthopaedic center , akron , oh , usa ) was retrospectively reviewed over a two year period ( 2010 to 2011 ) . implant waste was defined as "  during the course of a surgical procedure , it was unpackaged or otherwise prepared for use but ultimately did not remain implanted in the patient at the end of surgery and could not be reused in a different patient."15 ) all waste data was collected by the nursing staff during the operative procedure and recorded . a wasted implant financial report was posted in the surgery lounge starting the second year of the study . surgeon identity was not blinded , and each surgeon 's performance could be identified by his peers . this intervention year was compared to the prior year when the financial wasted implant data was not made available to the surgeon . the data was analyzed based on hip and knee arthroplasty implant waste as well as shoulder arthroplasty alone . potential differences between rates and proportions of occurrences were assessed with the use of a pearson chi - square test . significance was set at a two - tailed  < 0.05 . this project qualified for institutional review board exemption . in 2010 , 25 of 1,662 total hip arthroplasty ( tha ) and total knee arthroplasty ( tka ) cases had a waste event ( 1.50% ) for an average cost of $ 2,555.13 per event ( table 1 ) . in 2011 , 21 of 1,888 tha and tka cases had a waste event ( 1.11% ) for an average cost of $ 4,878.32 per event . the difference in proportions between 2010 and 2011 was 0.39%  0.75% ( 95% confidence interval [ ci ] ) . although there was a decrease is arthroplasty waste events between 2010 and 2011 , the reduction was not statistically significant ( p = 0.30 ) . the cost associated with waste accounted for 0.32% and 0.55% of the total cost associated with hip and knee arthroplasty implants in 2010 and 2011 , respectively . in 2010 , 7 of 206 shoulder arthroplasty cases had a waste event ( 2.47% ) for an average cost of $ 1,149.92 per event ( table 2 ) . in 2011 , 7 of 224 shoulder arthroplasty cases had a waste event ( 2.27% ) for an average cost of $ 626.46 per event . the difference in proportions between 2010 and 2011 was 0.27%  3.36% ( 95% ci ) . although there was a decrease is arthroplasty waste events between 2010 and 2011 , the reduction was not significantly significant ( p = 0.87 ) . the cost associated with waste accounted for 1.10% and 0.56% of the total cost associated with shoulder arthroplasty implants in 2010 and 2011 , respectively . in 2010 , 25 of 1,662 total hip arthroplasty ( tha ) and total knee arthroplasty ( tka ) cases had a waste event ( 1.50% ) for an average cost of $ 2,555.13 per event ( table 1 ) . in 2011 , 21 of 1,888 tha and tka cases had a waste event ( 1.11% ) for an average cost of $ 4,878.32 per event . the difference in proportions between 2010 and 2011 was 0.39%  0.75% ( 95% confidence interval [ ci ] ) . although there was a decrease is arthroplasty waste events between 2010 and 2011 , the reduction was not statistically significant ( p = 0.30 ) . the cost associated with waste accounted for 0.32% and 0.55% of the total cost associated with hip and knee arthroplasty implants in 2010 and 2011 , respectively . in 2010 , 7 of 206 shoulder arthroplasty cases had a waste event ( 2.47% ) for an average cost of $ 1,149.92 per event ( table 2 ) . in 2011 , 7 of 224 shoulder arthroplasty cases had a waste event ( 2.27% ) for an average cost of $ 626.46 per event . the difference in proportions between 2010 and 2011 was 0.27%  3.36% ( 95% ci ) . although there was a decrease is arthroplasty waste events between 2010 and 2011 , the reduction was not significantly significant ( p = 0.87 ) . the cost associated with waste accounted for 1.10% and 0.56% of the total cost associated with shoulder arthroplasty implants in 2010 and 2011 , respectively . several authors have previously reported the cost burden of implant waste within the disciplines of total joint arthroplasty,15 ) orthopaedic spine surgery,16 ) and orthopaedic trauma surgery.17 ) in these studies , an implant was considered waste when "  during the course of a surgical procedure , it was unpackaged or otherwise prepared for use but ultimately did not remain implanted in the patient at the end of surgery and could not be reused in a different patient."15 ) the first study , which examined waste in the subspecialty of total joint arthroplasty , demonstrated an average incidence of 2% and annualized average cost of over $ 100,000 per hospital.15 ) this extrapolates to $ 36 million dollars per year for the entire united states and a predicted $ 112 million per year with the anticipated increase in demand for total joint arthroplasty by 2030 . interestingly , there was no difference in incidence when comparing academic hospitals to community institutions . in contrast , a similar study examining orthopaedic trauma surgery found more waste in community hospital settings versus academic institutions . these authors additionally noted that the low incidence ( 0.6% ) and annualized cost ( $ 18,000 per hospital ) of trauma implant waste was unlikely to decrease significantly with even the most stringent of interventions.17 ) a third article investigating spine surgery implant waste noted an annualized cost of $ 126 million per year for the entire united states , similar to the first study , with waste occurring in approximately 20% of all cases.16 ) this study went further , however , and implemented an educational program on intraoperative waste for all operative room staff and posted a public , monthly tally of individual surgeon 's implant waste and associated cost burden , without anonymity ( spine ) . these achieved a remarkable 50% reduction in incidence ( 20.2% to 10.3% ) and a cost reduction of 66% ( $ 212,000 annually per hospital to $ 70,000 ) . the results from this study did show a trend toward decreasing waste events in the hip and knee arthroplasty as well as the shoulder arthroplasty group . after the wasted implant financial report was posted , 1.11% of all hip and knee arthroplasty cases had a waste event compared to 1.50% during the control year . although there was a decrease in waste events after posting the report , the reduction was not significantly significant ( p = 0.30 ) . this resulted in an absolute waste reduction was 0.39%  0.75% ( 95% ci ) . the cost associated with waste accounted for 0.55% and 0.32% of the total cost associated with hip and knee arthroplasty implants in the intervention and control year , respectively . when comparing to previously published arthroplasty implant waste literature,15 ) the results of this study showed a lower proportion of cost associated with implant waste for hip and knee arthroplasty ( 0.32% to 0.55% vs. 2% ) . the data from this study was recorded from a for - profit physician owned hospital ; thus , the surgeons may have already been aware of significant profit loss from implant waste . therefore , their surgical implant waste may have already been minimized prior to this study . shoulder arthoplasty waste accounted for 182% greater proportional cost than observed in hip and knee arthroplasty during the study period . in an effort to reduce implant waste , more attention should be paid to component trialing prior to implantation of the final prosthesis in order to achieve more accurate sizing . in addition , the final humeral bearing ( head or liner ) should not be opened on the sterile field until the shoulder is re - trialed with the definitive stem to ensure subsidence did not alter the final optimal humeral component size . it appears that with current techniques there will be a small percentage of cost associated with surgical implant waste during joint reconstruction surgery . it is the up to the surgeon and hospital system to continue to investigate methods to minimize surgical waste and the associated cost . the current healthcare climate in the united states is forcing both surgeons and healthcare systems to find novel ways to decrease healthcare costs while maintaining quality outcomes . posting a non - blinded wasted implant data sheet was associated with a reduction in the number of wasted orthopedic surgical implants in this series , although the reduction was not statistically significant . since shoulder arthroplasty represented 182% greater proportional cost than observed in hip and knee arthroplasty during the study period , shoulder arthroplasty represents an appropriate target to reduce healthcare costs with further implant waste reduction strategies .
backgroundrising health care costs and emphasis on value have placed the onus of reducing healthcare costs on the surgeon.methodsfinancial data from 3,973 hip , knee , and shoulder arthroplasties performed at a physician owned orthopedic hospital was retrospectively reviewed over a two - year period . 
 a wasted implant financial report was posted starting the second year of the study . 
 each surgeon 's performance could be identified by his peers.resultsafter posting of the financial report , 1.11% of all hip and knee arthroplasty cases had a waste event compared to 1.50% during the control year . 
 shoulder arthroplasty waste events occurred twice as often than that observed in hip and knee arthroplasty during the study period . 
 a decrease in waste events was observed but was not statistically significant ( p = 0.30).conclusionsposting a non - blinded wasted implant data sheet was associated with a reduction in the number of wasted orthopedic surgical implants in this series , although the reduction was not statistically significant .