Editor
Javad Parvizi MD FRCS
Professor Department of Orthopedic Surgery Rothman Institute Thomas Jefferson University
Philadelphia, Pennsylvania, USA
Co-editors
William J. Hozack MD
Professor Department of Orthopedic Surgery Rothman Institute Thomas Jefferson University
Philadelphia, Pennsylvania, USA
Peter F. Sharkey MD
Professor Department of Orthopedics Riddle Memorial Hospital
Media, Pennsylvania, USA
Gregory K. Deirmengian MD
Associate Professor Department of Orthopedic Surgery Sydney Kimmel Medical College Thomas Jefferson University
Philadelphia, Pennsylvania, USA
fm7Section Editors
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Rothman Institute Manual of Total Joint Arthroplasty: Protocol-Based Care
First Edition: 2017
9789386261052
Printed at:
fm5Dedication
Life brings us in contact with many. There are those we will remember forever. I dedicate this to those who have made an indelible mark in my life.
Javad Parvizi
- Scot Brown MD
- Fellow
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Antonia F. Chen MD MBA
- Assistant Professor
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Gregory K. Deirmengian MD
- Associate Professor
- Department of Orthopedic Surgery
- Sydney Kimmel Medical College
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- William J. Hozack MD
- Professor
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Paul B. McKenna MD
- Fellow
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Javad Parvizi MD FRCS
- Professor
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Peter F. Sharkey MD
- Professor
- Department of Orthopedics
- Riddle Memorial Hospital
- Pouya Alijanipour MD
- Clinical Fellow of Spine and Pediatric Orthopedic Surgery
- Children's Hospital of New Orleans
- Louisiana State University
- New Orleans, Louisiana, USA
- Matthew S. Austin MD
- Director of Joint Replacement Services
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Diana Bitar MD
- Fellow, Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Scot Brown MD
- Fellow, Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Jenny Cai BS
- Clinical Research Coordinator
- Department of Radiology
- University of Pennsylvania
- Philadelphia, Pennsylvania, USA
- David S. Casper MD
- Orthopedic Surgery Resident
- Rothman Institute
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Priscilla Ku Cavanaugh MD
- Orthopedic Surgery Resident
- Department of Orthopedic Surgery
- Drexel University College of Medicine
- Hahnemann University Hospital
- Philadelphia, Pennsylvania, USA
- Antonia F. Chen MD MBA
- Assistant Professor
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Corey T. Clyde MD
- Resident Physician
- Department of Orthopedics
- University at Buffalo
- Buffalo, New York, USA
- Carl A. Deirmengian MD
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Gregory K. Deirmengian MD
- Associate Professor
- Department of Orthopedic Surgery
- Sydney Kimmel Medical College
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Claudio Diaz-Ledezma MD
- Staff Orthopedic Surgeon
- Hospital Naval Talcahuano
- Talcahuano, Chile, USA
- Anthony J. DiMarino MD
- Professor
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Edward J. Filippone MD
- Clinical Associate Professor
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Seyedali R. Ghasemi MD
- Orthopedic Research Fellow
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Miguel M. Gomez MD
- Research Fellow, Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Robert P. Good MD
- Clinical Associate Professor
- Department of Orthopedic Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Christina J. Gutowski MD MPH
- Resident, Department of Orthopedic Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Michael F. Harrer MD
- Adult Reconstruction Surgeon
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Snir Heller MD
- Fellow, Department of Orthopedic Surgery
- Rabin Medical Center
- Petah Tikva, Israel
- Bryan A. Hozack MD
- Resident
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- William J. Hozack MD
- Professor
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Ronald Huang MD
- Resident Physician
- Department of Orthopedic Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- H. Jane Huffnagle DO
- Clinical Professor
- Thomas Jefferson University
- Suzanne Huffnagle DO
- Clinical Professor
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Fatih Kucukdurmaz MD
- Associate Professor
- Department of Orthopedics and Traumatology
- Bezmialem Vakif University
- Istanbul, Turkey
- Eric J. Levicoff MD
- Assistant Professor
- Sidney Kimmel Medical College
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Jess H. Lonner MD
- Associate Professor
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Jorge Manrique MD
- Fellow, Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Ryan Massimilla CCRP
- Clinical Study Manager
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Paul B. McKenna MD
- Fellow, Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Geno J. Merli MD
- Professor Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Joshua J. Minori DO
- Research Fellow, Department of Orthopedic Research
- Rothman Institute
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Philip Nimoityn MD
- Clinical Assistant Professor
- Department of Cardiology
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Alvin C. Ong MD
- Clinical Instructor Assistant Professor
- Rothman Institute
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Fabio Orozco MD
- Associate Professor
- Department of Orthopedic Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Javad Parvizi MD FRCS
- Professor, Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Ripal P. Patel MD
- Research Fellow
- Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Danielle Y. Ponzio MD
- Resident, Department of Orthopedic Surgery
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Zachary D. Post MD
- Adult Reconstruction Surgeon
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- James J. Purtill MD
- Professor of Orthopedic Surgery
- Sidney Kimmel Medical College
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Mohammad R. Rasouli MD
- Resident
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Camilo Restrepo MD
- Assistant Director
- Clinical Research
- Department of Orthopedics
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Maryam Rezapoor MS
- Research Fellow
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Richard H. Rothman MD PhD
- Professor
- Department of Orthopedic Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Eric S. Schwenk MD
- Assistant Professor of Anesthesiology
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Alisina Shahi MD
- Postdoctoral Research Fellow
- Department of Clinical Research
- Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Julie L. Shaner MD
- Resident
- Department of Orthopedics
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Peter F. Sharkey MD
- Professor
- Department of Orthopedics
- Riddle Memorial Hospital
- Media, Pennsylvania, USA
- Eric B. Smith MD
- Clinical Assistant Professor
- Department of Orthopedic Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Reza Mostafavi Tabatabaee MD
- Joint Reconstruction Fellow
- Rothman Institute
- Thomas Jefferson University
- Timothy L. Tan MD
- Resident, Department of Orthopedic Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- T. David Tarity MD
- Adult Reconstruction and Joint Replacement Fellow
- Department of Orthopedic Surgery
- Hospital for Special Surgery
- New York City, New York, USA
- Lynda J. Thomson Pharm D CACP
- Advance Practice Pharmacist
- Department of Pharmacy/Surgery
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Eric H. Tischler BA
- Research Fellow
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Brian T. Urbani MS
- Clinical Research Coordinator
- Department of Orthopedic Surgery
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Jessica R. Viola BS
- Research Fellow, Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Eugene R. Viscusi MD
- Professor
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Kristen Vogl DPT MBA
- Director of Clinical Services
- Administrator Musculoskeletal Service Line
- Thomas Jefferson University Hospital
- Philadelphia, Pennsylvania, USA
- Meng-Huang Wu MD
- Attending Physician
- Department of Orthopedics
- Taipei Medical University Hospital
- Taipei, Taiwan
- Je-Hyun Yoo MD PhD
- Associate Professor
- Department of Orthopedic Surgery
- Hallym University Sacred Heart Hospital
- Anyang, South Korea
- Benjamin Zmistowski MD
- Resident
- Thomas Jefferson University Hospital
Orthopedic surgery and the delivery of care to patients have entered a new era. The financial pressure on the healthcare has compelled us to examine the cost-effectiveness of our practices and care protocols. The easy access to information on the Internet has generated well-read and fairly informed patients. The various grading systems for the doctors and the hospitals, together with the satisfaction scores from patients have all led to a rush to change the manner in which we deliver care. The recent changes in healthcare reimbursements and introduction of “bundling” in the US have further compelled the medical community to seek strategies that will allow delivery of high quality and cost-effective care.
At our institution, we have been a believer in protocol-based care that allows efficient and cost-effective care. If these protocols are based on evidence, they provide further improvements in patient outcomes and serve to reduce cost. I am proud to present to you this book that summarizes many, if not all, the protocols that we have implemented at the Rothman Institute. The impetus behind writing this book is the numerous inquiries from colleagues and friends who have reached out to us asking for our protocols in various areas. We hope that having all of the institutional protocols will help our colleagues in the field to deliver greater care to their patients without having to reinvent the wheel. We realize that orthopedics is a fluid science, and many of these protocols will change in the future, if not changed by the time this book is printed. We will strive to keep the readers of this book informed of those changes by printing supplemental material in the future.
fm17Acknowledgments
The completion of this book would not be possible without the immense help of many whose names do not appear in the author list. We would like to thank Katherine Huff and Krystal Golankiewicz for proofreading the chapters. Special thanks to the nurses and other residents on the orthopedic service who provided insight to the authors during the preparation of the chapters to ensure that the protocols were accurately presented.