Does Implant Design Affect Hospital Metrics and Patient Outcomes? TKA Utilizing a “Fast-Track” Protocol


  • Richard Buch Dallas Limb Restoration Center, Dallas, TX-USA
  • Lennart Schroeder University of Wuerzburg, Wuerzburg-Germany
  • Rylie Buch Dallas Limb Restoration Center, Dallas, TX-USA
  • Robert Eberle Dallas Limb Restoration Center, Dallas, TX-USA



Fast Track, customized, Total Knee Arthroplasty



“Fast-Track” protocols have been introduced in TKA with the intention to increase health care savings while maintaining or improving patient outcomes. The influence of the implant design in a “Fast-Track” setting has not been described yet. The primary goal of this study was to compare a customized implant with standard off-the-shelf (OTS) devices when utilizing a “Fast-Track” protocol


Sixty-two (62) patients were prospectively enrolled at a single center and implanted with either a customized or a standard off-the-shelf implant resulting in thirty (30) patients being treated with an OTS design and thirty-two (32) with the customized design. The same institutional fast-track protocol was utilized on all patients and included pre-, intra-, and postoperative medical treatment. We assessed total length of stay (LOS), discharge destination and range of motion at 6-8 weeks post-op and at an average of 16 months post-op follow-up to compare the OTS implant with the customized device. Implant survivorship was assessed at a minimum of 25 months post-op.


Using the fast track protocol we were able to decrease overall LOS to 2.1 days versus 3.6 days prior to introduction of the protocol. The use of the customized implant further reduced LOS significantly to 1.6 days. Significantly higher number of patients who got implanted with the customized device (66%) were discharged within 24 hours than in the OTS group (30%). Patients treated with the customized implant were found to be discharged home more often than patients treated with the OTS implants (97% vs. 80%) and achieved higher range of motion both at 6-8 weeks (114° vs. 101°) and at an average of 16 months (122° vs. 114°) than patients who got treated with the OTS device. At an average follow-up of 28 months, there was 1 implant revision in the customized group (due to tibial fracture resulting from patient fall). For the OTS group there was 1 implant revision (late infection) and 1 poly swap (due to instability).


Based on our analysis we observed a positive influence of the customized device on patient outcomes and hospital metrics and we therefore conclude that the implant choice is an important factor for TKA in a “fast-track” setting.


Rodriguez-Merchan, E. Carlos. "Pros and cons of fast-track total knee arthroplasty." International Journal of Orthopaedics 2.3 (2015): 270-279.

Husted, Henrik, Gitte Holm, and Steffen Jacobsen. "Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients." Acta orthopaedica 79.2 (2008): 168-173.

Holm, Bente, et al. "Loss of knee-extension strength is related to knee swelling after total knee arthroplasty." Archives of physical medicine and rehabilitation 91.11 (2010): 1770-1776.

Kehlet, Henrik, and Douglas W. Wilmore. "Evidence-based surgical care and the evolution of fast-track surgery." Annals of surgery 248.2 (2008): 189-198.

Kehlet, Henrik, and Jørgen B. Dahl. "Anaesthesia, surgery, and challenges in postoperative recovery." The Lancet 362.9399 (2003): 1921-1928.

Wu, Christopher L., et al. "Correlation of postoperative pain to quality of recovery in the immediate postoperative period." Regional anesthesia and pain medicine 30.6 (2005): 516-522.

Jans, Øivind, et al. "Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast‐track hip and knee arthroplasty." Transfusion 54.3 (2014): 717-726.

Wilmore, Douglas W., and Henrik Kehlet. "Recent advances: Management of patients in fast track surgery." BMJ: British Medical Journal 322.7284 (2001): 473.

Kehlet, Henrik, and Emmanuel Thienpont. "Fast-track knee arthroplasty–status and future challenges." The Knee 20 (2013): S29-S33.

Kehlet, Henrik, and Kjeld Søballe. "Fast-track hip and knee replacement—what are the issues?." Acta orthopaedica 81.3 (2010): 271-272.

White, Paul F., et al. "The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care." Anesthesia & Analgesia 104.6 (2007): 1380-1396.

Culler, Steven D., Greg M. Martin, and Alyssa Swearingen. "Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty." Arthroplasty Today (2017).

Schwarzkopf, Ran, et al. "Surgical and functional outcomes in patients undergoing total knee replacement with patient-specific implants compared with “off-the-shelf” implants." Orthopaedic journal of sports medicine 3.7 (2015): 2325967115590379.

Bozic, Kevin J., et al. "Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty." The Journal of arthroplasty 21.6 (2006): 151-156.

Munin, Michael C., et al. "Predicting discharge outcome after elective hip and knee arthroplasty." American journal of physical medicine & rehabilitation 74.4 (1995): 294-301.

Pablo, Paola de, et al. "Determinants of discharge destination following elective total hip replacement." Arthritis Care & Research 51.6 (2004): 1009-1017.

Ramos, Nicholas L., et al. "Correlation between physician specific discharge costs, LOS, and 30-day readmission rates: an analysis of 1,831 cases." The Journal of arthroplasty 29.9 (2014): 1717-1722.

Barad, Steven J., Stephen M. Howell, and Joyce Tom. "Is a shortened length of stay and increased rate of discharge to home associated with a low readmission rate and cost-effectiveness after primary total knee arthroplasty?." Arthroplasty Today (2015).

Healy, William L., et al. "Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty." JBJS 84.3 (2002): 348-353.




How to Cite

Buch, R., Schroeder, L., Buch, R., & Eberle, R. (2019). Does Implant Design Affect Hospital Metrics and Patient Outcomes? TKA Utilizing a “Fast-Track” Protocol. Reconstructive Review, 9(1).