Utilization of a “Rep-Less Model” in Primary Joint Arthroplasty: Lessons Learned

Introduction: The aim of this study was to describe the process of utilizing a “repless” model, assess its efficacy, and analyze the cost savings in primary hip arthroplasty.

Methods: Between June and December 2016, 50 cases of primary, straightforward total knee arthroplasties were performed with the repless model. The responsibilities of the rep were divided into 2 categories for better management: 1) Familiarity of the instruments, implant, and techniques; trays set up and assurance of availability of the implants. These responsibilities were covered by a trained OR technician and the surgeon, and 2) Final verification of the accurate implants prior to opening the packaging. This was done by a trained OR nurse and the surgeon.

Results: We did not have any intra-operative complications and did not encountered any issued with the trays or errors in opening of the implants. There were no re-admissions, fracture, dislocation, or infection. The mean length of stay was 2.2 ± 0.5 days (range 1-3 days) with 68% home discharges. The cost of the implant was reduced from $4,800 to $1,895 with $2,905 cost saving per case and total savings of $145,250. Further cost saving was seen in central sterile processing time, reduction in trays and 27% improvement in turnover time.

Conclusion: Repless model has significant cost saving potential. Preparation for the transition, proper patient selection, standardization of the trays and implants, and distribution of the responsibilities between OR nurses, technicians and the surgeon are essential.