Single-Use Custom Instrumentation in Total Knee Arthroplasty: Effect on In-Hospital Complications, Length of Stay, and Discharge Disposition

Total knee arthroplasty (TKA) is a quality surgical intervention with rapidly increasing use. This growth has brought with it a host of new technologies, including custom instrumentation (CI). With the current emphasis on value-based health care, the clinical benefit of CI TKA must be evaluated. The goal of this study was to compare CI and conventional TKA regarding multiple quality metrics, in-hospital complications, length of stay, and discharge destination. The authors propensity score matched 231 conventional TKAs to 231 consecutive CI TKAs for age, sex, and body mass index. Preoperative risk factors analyzed were age, sex, body mass index, and preoperative hemoglobin. Perioperative factors included transfusion rate, hemoglobin drop, hemovac output, operative time, length of stay, discharge disposition, deep venous thrombosis and pulmonary embolism rates, and in-hospital vital sign data. There were no differences in preoperative demographics between groups. Postoperatively, there was no difference between conventional and CI TKA in operative time, transfusion rate, discharge hemoglobin, length of stay, discharge disposition, or in-hospital venous thromboembolism rates. In the conventional and CI groups, length of stay was 2.6 and 2.5 days (P=.43) and discharge disposition was 82% home and 83% home (P=.90), respectively. Although CI TKA is commonly implemented, in this analysis, compared with conventional TKA, it was not associated with any difference in length of stay, discharge disposition, operative time, transfusion rate, or in-hospital complications.