Second Chances: A Pediatric Orthopaedic Society of North America Survey and Review of Current Practices and Attitudes Toward the Reuse of Deep Orthopaedic Implants

Background: Little has been published surrounding the safety and utility of deep implant reuse in children. Pediatric orthopaedic surgeons report reuse of deep implants in specific settings—namely during medical outreach trips outside of North America and Europe. Evaluation of existing literature demonstrates lack of clarity as to appropriate reprocessing, monitoring, and reporting practices for deep implant reuse. Methods: Existing literature was reviewed, and a Pediatric Orthopaedic Society of North America (POSNA) membership survey of 34 questions was conducted online. Results: Surveyed POSNA members indicated they reuse deep implants predominantly outside of North American centers, but many members expressed willingness to expand this practice if knowledge and infrastructure were bolstered to support it. Conclusions: The results of this literature review and survey indicate potential to expand deep implant reuse with potential benefits to health access, equity, cost, and the environment. Doing so, however, should be predicated on the results of further research and infrastructure to enable practice change and implementation safely and equitably. Key Concepts: (1) A survey of Pediatric Orthopaedic Society of North America members indicates widespread interest in expanding knowledge about deep implant reuse, particularly as it relates to safety and indications. (2) Deep implant reuse has the potential to reduce waste and cost while expanding access to needed implants in low-resource settings. (3) Currently, a lack of outcomes and complications data, limitations in implant-tracking programs, medicolegal constraints, manufacturer single-use designations, patient perceptions, and limited infrastructure and funding for reprocessing programs limit capacity for implant reuse across most settings. (4) Surgeons utilizing reprocessed implants should disclose this as well as how they ensure reused implant integrity and sterility with patients during informed-consent discussions. (5) Collaboration between pediatric orthopaedic surgeons across diverse geographies including low-, middle-, and high-income settings are needed to determine the optimal indications for and practices related to safety and quality assurance in deep orthopaedic implant reuse. National and international societies have a key role to play in enabling outcome sharing and knowledge on this topic.