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Updated: Oct 1, 2025

Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital
Adam J Taylor1, Robert D Kay, Jason A Bryman
1From the Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA (Dr. Taylor, Dr. Kay, Dr. Bryman, and Dr. Tye); the Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA (Dr. Taylor, Dr. Kay, Dr. Bryman, Dr. Tye, Dr. Longjohn, Dr. Najibi, and Dr. Runner); and the Department of Orthopaedic Surgery, Keck Medical School of University of Southern California, Los Angeles, CA (Dr. Longjohn).
Introduction:
Rapid recovery protocols (RRPs) for total joint arthroplasty (TJA) can reduce hospital length of stay (LOS) and improve patient care in select cohorts; however, there is limited literature regarding their utility in marginalized patient populations. This report aimed to evaluate the outcomes of an institutional RRP for TJA at a safety net hospital.
Methods:
A retrospective review of 573 primary TJA patients was done, comparing the standard recovery protocol (n = 294) and RRP cohorts (n = 279). Measured outcomes included LOS, 90-day complications, revision surgeries, readmissions, and emergency department visits.
Results:
The mean LOS reduced from 3.0 ± 3.1 days in the standard recovery protocol cohort to 1.6 ± 0.9 days in the RRP cohort (P < 0.001). The RRP cohort had significantly fewer 90-day complications (11.1% versus 21.4%, P = 0.005), readmissions (1.4% versus 5.8%, P = 0.007), and revision surgeries (1.4% versus 4.4%, P = 0.047).
Conclusion:
A RRP for primary TJA can be successfully implemented at a safety net hospital with a shorter LOS and fewer acute adverse events. Such protocols require a coordinated, multidisciplinary effort with strict adherence to evidence-based practices to provide high-quality, value-based surgical health care to an underserved cohort.
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