Nonunion of a pertrochanteric femur fracture due to a low-velocity gunshot.

: To meet the needs of increasing demand for total knee arthroplasty, the individual surgeon must focus on improving proficiency and volume. Improved efficiencies in total joint arthroplasty (TJA) have many benefits beyond meeting the increasing demand by patients for joint replacement, however. Surgeons and institutions that perform a higher volume of TJAs have lower rates of mortality, complications, and readmissions compared with surgeons and institutions that perform a lower volume of TJAs. Surgeons and hospitals must commit to the resources that can improve their TJA volume and, in turn, their overall TJA outcomes. Implementing "swing," or parallel, operating rooms, dedicating the surgeon to performing the TJA procedure only, and utilizing customized patient instrumentation to identify ideal surgery scheduling practices and to decrease surgical time can increase performance and patient satisfaction.