BOA Annual Congress 2025

Author - Charmilie Chandrakumar

Purpose

Implant wastage in trauma and orthopaedic (T&O) surgery remains an under-reported yet significant issue, contributing to rising healthcare costs and environmental concerns. With increasing surgical demand driven by an ageing population and the growing prevalence of conditions like osteoporosis, this study aimed to quantify implant wastage in T&O procedures at a Level 1 Major Trauma Centre in London, assessing both its frequency and financial impact.

Methods

A retrospective cohort study was conducted on all weekday T&O procedures performed between 1st December 2023 and 31st January 2024. Two of the authors identified wasted implants using intraoperative implant logbooks, and cross-referencing implant stickers with post-operative radiographs. Data pertaining to patient demographics, procedure types, surgical sites, and implant usage were collected. Cost analysis was performed using procurement data to determine the financial impact of implant wastage.

Results

Among 184 procedures analysed, 131 (71.2%) used implants, with wastage observed in 108 (82.4%) cases. A total of 141 implants were wasted, with screws accounting for 92.9% (n = 131) of wasted implants. Locking screws were the most frequently discarded (n = 65; 46.1%). Across ORIF and intramedullary nailing procedures, an overall screw wastage rate of 20% (17–31%) was observed with 2.4 screws wasted per trauma procedure. The financial cost of implant wastage over the 44-day study period amounted to approximately £335 per day and £136 per case.

Conclusion

This study highlights the substantial economic burden associated with implant wastage in T&O surgery, with screws, particularly locking screws, being the primary contributors. Targeted interventions, including improved preoperative planning, precision-based implant selection, and enhanced intraoperative decision-making, are essential to reducing waste and improving cost-efficiency and sustainability in surgical practices. Further research should explore the broader economic and environmental impact of implant wastage, incorporating factors such as operative time and carbon footprint to develop comprehensive waste-reduction strategies.

Predicting the survival of Meniscal Allograft Transplants – a multi-centre cohort study

Authors – Dylan Mistry, Faizan Arshad, Nicholas Smith, Tim Spalding

Background

Meniscus deficit knees do not benefit from the functions of the meniscus such as load distribution and chondroprotection. Meniscal allograft transplant (MAT) is a novel surgical management option and the MRI appearance in Meniscal Transplant Score (MIMS) is a validated tool for MAT health, scored out of 11. This study aimed to evaluate whether MIMS were predictive of patient related outcome measures (PROMS) or failure rate.

Methods

A retrospective study was carried out on a prospectively collected database of MAT patients in multiple centres. MIMS scores, relative percentage extrusion (RPE) and cartilage grading were judged based on an MRI scan taken one year post-operatively. Regression analysis and survival analysis were then used to predict the improvement in PROMS data from pre-operatively levels (KOOS 4 taken at year 1, 2, 3, 5, 10) and survival of the MAT.

Results

Of the 218 MAT patients with a mean follow up of 4.95 years, mean MIMS score was 6.87 (1–11) and RPE 36% (0-100). Mean improvement in KOOS 4 score was 21.2 (-34–79.5) pre- and post-operatively. As part of regression analysis, MIMS was shown to predict an improvement in KOOS 4 scores (p=0.002) but RPE was not significant (p=0.096). Fifteen patients experienced failure of their MAT, at a mean time of 3.65 years. Both MIMS and RPE were able to predict failure (p=0.007 and 0.004 respectively), as did survival analysis when splitting the cohort with a MIMS score ³6 or <6 (p=0.005), but cartilage grading did not.

Conclusion

This study is the first to our knowledge to compare a recognised MAT assessment tool to PROMS. This gives clinicians treating patients with a MAT the ability to predict the likely success and survival of the transplant based on the MRI findings at 1 year post-operatively.