Comparison of the logistics between the conventional instruments and patient-specific templating in total knee replacement in the low-income setting

Background: Total knee replacement (TKR) is a complex operation and its conventional instrumentation system has around 300 pieces to perform and more than 50 technical steps. New techniques were introduced, such as patient-specific instrumentation (PSI), robotics, and navigation to facilitate the TKR operation. This study aims to compare the logistics between conventional instrumentation and patient-specific templating (PST) in the lowincome setting. Methods: We compared the logistics for the conventional and the PST techniques while performing TKR. The comparison included the number of instruments and trays, equipment delivery, packaging, sterilization, intraoperative setup, and post-operative handling. Results: The surgical trays to complete one conventional TKR were 6-12 trays while for the PST, only one tray was needed. Conventional instruments can reach the hospital in 24 h while the delivery time of the PST may take from 3 to 5 days. The time needed to sterilize the conventional could be done overnight in the small hospitals as compared to a few hours in PST. In addition, PST has no special postoperative steps, unlike the conventional, which requires washing, delivery to a storage facility, re-washing, decontamination, packing, and storing till the next surgery. Conclusion: The logistics for conventional instruments are more complex. Although there was no costeffectiveness analysis, it has been observed that the PST technique has a positive effect on rationalizing resources by consuming less time in the central sterilization unit and reducing the operating time.