Medicare has paid for total hip replacement in ASCs since 2021, yet many ASC hip procedures still run on instrument trays built for hospital-scale sterile processing. Total hip arthroplasty joined the ASC covered procedures list for 2021,¹ and revision total hip followed for 2026.² Surgeon interest is not the constraint. The instrument flow is. Scaling ASC hip procedures takes one complete kit per case instead of a stack of partially used trays, so the schedule no longer waits on sterile processing to turn sets between cases.
For ASC administrators, OR leaders, and hip implant OEMs, that shift means running hip cases at volume without adding sterile processing staff. This article shows what it is worth in turnover time and capacity, and what a complete hip kit needs to include.
A typical hip system contains more instruments than the surgeon needs. In a Rothman Orthopaedic Institute study of 35 primary total joint cases, surgeons used only 36.0 percent of the instruments opened for total hip arthroplasty.³ A Lean review removed 46 of 112 instruments and cut the hip set to two trays. Mean setup time fell from 27.9 to 18.6 minutes, and the team saved 45 to 150 minutes during processing.³
Those numbers describe a common problem. Every unused instrument still gets washed, inspected, wrapped, sterilized, and stored. Each step consumes staff time that many ASCs do not have, and the work repeats after every case.
For an ASC, this burden lands on a small team. A hospital sterile processing department may run several shifts with dedicated instrument technicians. Many surgery centers rely on a few staff members who also cover other duties, so one late hip tray can delay every case that follows it.
Hip programs also face pressure points specific to the procedure. Broach and reamer sizing adds instruments in a range of sizes, and most of them go unused in any single case. Loaner sets can arrive late from the vendor. When an instrument goes missing or arrives unsterile, teams often turn to immediate-use steam sterilization. A review of hip and knee arthroplasty cases at an academic medical center found that staff cited OR turnover as the reason in 37.5 percent of immediate-use sterilization events, and only 9.5 percent of cases met an acceptable indication.⁴ That pattern reflects a schedule straining against instrument availability, and it adds infection-control exposure an ASC would rather avoid.
Time is the primary economic driver in an ASC. Rooms, staff, and anesthesia hours carry a fixed cost, so every minute saved in turnover either creates capacity or reduces overtime.
A published cost model quantified that effect for joint replacement. It simulated 100,000 cases across 200 sites and applied a turnover-time saving of about 17.5 minutes per case for sterile-packed, single-use instruments, averaged from four published studies.⁵ With those savings, an additional case could fit on 51 percent of 12-hour OR days, 29 percent of 10-hour days, and about 11 percent of 8-hour days. With traditional reusable instruments, an additional case fit on less than 1 percent of days at every day length.⁵
The model also tracked overtime. Traditional instruments pushed 35 to 38 percent of operating days into staff overtime, compared with less than 1 percent for single-use instruments.⁵
The model studied total knee arthroplasty, not hip. Hip programs run on similar multi-tray workflows, so the direction should hold, but each ASC should run its own numbers.
Here is what that looks like on a hip schedule. Picture an ASC that runs two 12-hour joint days a week. If an extra arthroplasty fits on about half of those days, the center gains roughly one additional case a week. Across 50 operating weeks, that adds about 50 cases a year without another room or another shift. The fixed costs stay the same while the case count rises, and the schedule becomes easier to predict for surgeons, staff, and patients.
The overtime finding matters as much as the extra case. Overtime hours fall on the same nurses, surgical technologists, and sterile processing staff that an ASC works hard to retain. A schedule that finishes on time most days is easier to staff, and it gives surgeons confidence to book the next block.
A complete hip kit starts with the implant system. It includes only the instruments that the stem and cup system requires, matched to the surgeon's technique, so the back table holds what the team will use. The Rothman data shows why that matters: when nearly two-thirds of opened instruments go unused, every case pays for work that adds nothing to the outcome.³
Packaging matters as much as content. A sterile-packed, labeled, and lot-traceable kit shortens the chain of custody from manufacturer to OR. Staff confirm one sealed package instead of counting several trays, which removes count discrepancies from turnover and supports cleaner documentation.
Kits also simplify inventory. Storage holds sealed kits by implant system rather than racks of wrapped trays waiting for reprocessing, and materials managers can reorder against the case schedule.
Consistency completes the picture. The same configuration arrives at every site and for every case, so staff learn one setup and repeat it. New team members train faster, and surgeons see the same layout whether they operate on Monday or Friday. That predictability supports the single-use large joint kit model for hip, knee, and shoulder and fits within a broader procedure kit program.
Scaling ASC hip procedures takes coordinated work from both partners.
The OEM's role is to adopt an optimized and tailored, validated and surgery ready™ procedural kit solution. That shift also changes the OEM's balance sheet. Loaner sets in transit and on shelves represent capital that sits idle between cases. A kit program ties instrument spend to procedures performed and lets the OEM add ASC accounts without building more sets that cost $20,000 to $30,000 or more per tray. Up to 8 or even 9 reusable instrument trays are needed per case.
The ASC's role is to schedule against known kit availability rather than tray turnaround. Sterile processing staff can then focus on the cases that still need reusable instruments, rather than reworking hip trays between back-to-back joints. Clear handoffs keep the model working: OEMs share kit configurations and lead times, and ASCs share block schedules and surgeon preferences, so kits arrive matched to the cases on the board. Teams that have studied how single-use kits reduce OR turnover time and sterile processing burden will see the same logic applied to hips.
The shared result is predictable surgery at scale for ASC hip procedures. Fewer variables stand between the patient and the incision. Questions about immediate-use steam sterilization in hip and knee replacement come up less often because the instruments arrive ready.
The case for complete hip kits rests on three findings. Unused instruments carry real reprocessing cost. Turnover minutes saved can turn into additional cases on a meaningful share of operating days. And a single, complete surgery ready™ kit converts both gains into a repeatable system that works at every site every day and provides a monetized solution. Coverage for hip procedures will continue to expand. The ASCs and OEMs that remove instrument friction now will capture that growth with the rooms and staff they already have. The first step is a clear look at how many instruments each hip case opens today.
ECA Medical works with hip implant OEMs and ASCs to design and deliver sterile-packed, procedure-specific kits. See how the Surgery-Ready™ solutions work, or contact the ECA team to plan your hip program.
Can total hip replacement be performed in an ASC?
Yes. Medicare added total hip arthroplasty to the ASC covered procedures list for 2021.
Is revision hip arthroplasty covered in ASCs?
Yes. CMS added revision total hip arthroplasty to the ASC covered procedures list for 2026.
How do single-use hip kits affect OR turnover?
They remove tray opening, counting, and breakdown steps. A published total knee cost model applied about 17.5 minutes of turnover savings per case, and hip workflows follow a similar multi-tray pattern.
What should an ASC look for in a hip procedure kit?
Look for implant-specific instruments, sterile packaging, lot traceability, and the same configuration at every site.
1. Centers for Medicare & Medicaid Services. CY 2021 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system final rule (CMS-1736-FC). Fact sheet.
2. Bosek H. The procedures that shifted to the outpatient model in 2026. Becker's ASC Review. September 4, 2026.
3. Lonner JH, Goh GS, Sommer K, Niggeman G, Levicoff EA, Vernace JV, Good RP. Minimizing surgical instrument burden increases operating room efficiency and reduces perioperative costs in total joint arthroplasty. J Arthroplasty. 2021;36(6):1857-1863.
4. Zuckerman SL, Parikh R, Moore DC, Talbot TR. An evaluation of immediate-use steam sterilization practices in adult knee and hip arthroplasty procedures. Am J Infect Control. 2012;40(9):866-871.
5. Goldberg TD, Maltry JA, Ahuja M, Inzana JA. Logistical and economic advantages of sterile-packed, single-use instruments for total knee arthroplasty. J Arthroplasty. 2019;34(9):1876-1883.e2.
