Describe the standard steps of instrument and implant counting before and after arthroplasty surgery and explain why it is critical.

• A. Count at skin incision only.
• B. Count at skin incision and again before wound closure.
• C. Count at skin incision, during key intraoperative steps, and before wound closure.
• D. Count only after wound closure.

Answer: (C)

Instrument and implant counting in arthroplasty is a safety check that must happen at multiple points to prevent leaving items inside the patient. The best approach is to establish a baseline count at the skin incision, then perform counts again during key intraoperative steps whenever implants or components are opened, added, exchanged, or removed. A final confirmation before wound closure ties the process together, ensuring nothing was misplaced or left behind as the surgery concludes. This multi-time-point strategy catches discrepancies early, allows immediate action (like rechecking or imaging if needed), and is the standard of care to protect the patient from retained foreign bodies and the associated complications and liability. Counting only at the start or only at the end can miss items used mid-procedure or fail to detect a mismatch until after closure, which is why the comprehensive, staged approach is essential.