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Patient Positioning System FAQ

Femoral exposure is often the rate-limiting step in direct anterior total hip arthroplasty. The Dominion Surgical System combines precise, surgeon-controlled positioning with a patented femoral lift designed to elevate the femur from below. Unlike systems that rely on pulling the femur upward with a power hook, the femoral lift pushes upward to support controlled elevation and exposure. Surgeons can also make real-time adjustments to pelvic, hip, and limb positioning, helping make femoral preparation more efficient and reproducible.

Dominion Patient Positioning System (PPS) Surgeon-directed positioning during anterior hip procedures

During DAA THA, subtle changes in rotation or extension can significantly alter exposure and implant access. When the operating surgeon controls positioning directly, those adjustments happen immediately and intentionally. That improves procedural flow and reduces the friction that comes from repeated verbal instructions to non-sterile or non-experienced staff.

Accurate cup inclination, anteversion, offset restoration, and leg length assessment all depend on consistent pelvic orientation and reproducible limb positioning.  A stable, technology-independent, radiolucent platform gives the surgeon reliable references throughout the case, particularly when using fluoroscopy or templating to confirm reconstruction goals.

Efficiency gains in anterior THA usually come from eliminating small delays that accumulate during the procedure. Faster positioning, real time adjustments by the operating surgeon, more predictable femoral exposure, and less dependence on additional staff can shorten operative and nonoperative portions of the case and create a smoother overall workflow. Individual results may vary. Technique and outcomes are at the discretion of the operating surgeon.

Slide titled “Peer-Reviewed Evidence” showing operational efficiency of off-table techniques in direct anterior hip replacement. Text states off-table techniques reduce operating room time by 43 minutes per case, enabling one additional case per day. A bar chart compares off-table versus on-table times for setup, surgical time, and total room time, with off-table lower in all categories. A blue callout reads “+1 case a day.” Reference listed at bottom.

Peer-Reviewed Evidence: Off-table techniques reduce operating room time by 43 minutes per case, enabling +1 case/day¹

Owen TM, Horberg JV, Corten K, Moskal JT. The off-table technique increases operating room efficiency in direct anterior hip replacement. Arthroplasty Today. 2022;15:167-173.

Standard OR tables can work for selected surgeons, but they often require additional manual assistance and may offer less precise control during femoral exposure. A purpose-built patient positioning system is designed specifically for the motions required during DAA arthroplasty, helping the surgeon achieve exposure in a more controlled and repeatable manner.

Yes. Surgeons early in their careers can benefit from having complete control of the operative leg throughout the procedure. With the Dominion Patient Positioning System, the surgeon can make precise, real-time positioning adjustments independently, helping reduce variability and allowing greater focus on exposure, technique, and soft tissue management.

Anterior THA can become physically demanding when exposure requires repeated manual manipulation of the extremity. Controlled mechanical positioning reduces unnecessary force and awkward body mechanics, which can lessen surgeon fatigue over the course of a full operative day.

When positioning changes are intuitive and immediate, communication becomes simpler and the team can stay focused on their primary responsibilities. Scrub staff remain engaged in the sterile field, anesthesia is less disrupted, and circulating staff are not repeatedly pulled away for table adjustments.

Absolutely. In ASCs, efficiency, room turnover, and lean staffing models are critical. A compact, purpose-built positioning platform that streamlines anterior THA workflow can help surgeons maintain throughput while supporting the clinical demands of same-day arthroplasty.

Even experienced surgeons often adapt their technique around the limitations of their equipment. A system designed specifically for anterior hip arthroplasty may allow more efficient exposure, smoother workflow, improved ergonomics, and greater intraoperative control. For high-volume surgeons, even small improvements per case can become meaningful over time.

Legacy specialty tables helped standardize direct anterior THA, but many surgeons now want greater simplicity, improved workflow, and more intuitive intraoperative control. The Dominion Patient Positioning System is designed around modern arthroplasty efficiency—focusing on surgeon-directed positioning, streamlined setup, and reduced dependence on multiple staff members during critical portions of the case.

While newer minimalist systems may reduce equipment footprint, many still retain the same reliance on outside sterile operators for positioning adjustments. The Dominion Patient Positioning System takes a different approach by giving the surgeon direct control throughout acetabular and femoral preparation. Rather than simply reducing the size of traditional positioning technology, the system was designed to address the underlying workflow challenges with greater surgeon control and procedural integration.

Many surgeons become highly efficient on a legacy specialty table, but experience also reveals where time is lost: setup complexity, communication delays for adjustments, room footprint, or maintenance burdens. A newer system may offer the same exposure goals with fewer workflow obstacles. For high-volume surgeons, even small efficiency gains per case can be meaningful.

The Dominion Patient Positioning System has a total weight of approximately 30 pounds and is designed with a significantly smaller footprint than traditional specialty tables. The system breaks down for convenient storage in a suitcase-sized case or can be stored on an OR shelf, helping conserve valuable operating room space and simplify storage between procedures.

Some legacy systems rely heavily on circulating staff or additional personnel for repeated adjustments during the case. A surgeon-controlled platform can reduce those interruptions and allow the team to stay focused on their primary responsibilities. In lean staffing environments, that advantage becomes even more relevant.

Some workflow adjustment is expected when adopting new surgical technology. The Dominion Patient Positioning System, however, was designed and validated with extensive input from experienced traditional specialty table users. Their feedback helped ensure the system integrates with familiar anterior approach techniques, resulting in minimal changes to established surgical workflow.

Bud Tyler, Dominion Surgical Member Portrait

Bud Tyler

Board Advisor

Bud Tyler is a manufacturing executive with more than 45 years of experience in precision manufacturing for the medical device, aerospace and defense industries. He began his career in 1977 at an eye-surgery device manufacturer that was acquired by Johnson & Johnson, where he served as Director of Materials for its IOLAB division, and went on to spend more than 30 years as Vice President of The EF Precision Group in Willow Grove, Pennsylvania, a consultative contract manufacturer of close-tolerance machined components and turnkey assemblies for medical, aerospace, defense and OEM customers. He is now the founder and principal advisor of Continuum Advisors for Manufacturers. As a member of Dominion Surgical’s Board of Advisors, he brings manufacturing and materials management experience to the company.

Gautam Siram, Dominion Surgical Member Portrait

Gautam Siram, MD

Surgeon Design Advisor

Gautam Siram, MD is a board-certified orthopaedic surgeon with Summit Orthopedics, a division of The Centers for Advanced Orthopaedics in Chevy Chase, Maryland, where he has practiced since 2012, with hospital affiliations at Sibley Memorial Hospital and Suburban Hospital. His practice focuses on adult hip and knee reconstruction, including the muscle-sparing anterior approach for hip replacement, minimally invasive partial and total knee replacement, and complex revision surgery. Dr. Siram earned his medical degree from the Mount Sinai School of Medicine, completed his orthopaedic residency at Howard University Hospital and completed an adult reconstruction fellowship at the Anderson Orthopaedic Clinic. He is a member of the American Association of Hip and Knee Surgeons. He serves as a surgeon design advisor on Dominion Surgical’s Board of Advisors, and Capital Orthopaedic Surgery Center in Germantown, Maryland is his Dominion Patient Positioning System training site.

Brian Blackwood, Dominion Surgical Member Portrait

Brian Blackwood, MD

Surgeon Design Advisor

C. Brian Blackwood, MD is a board-certified, fellowship-trained orthopaedic surgeon with BoulderCentre for Orthopedics & Spine in Boulder, Colorado, which he joined in 2013 after practicing at the Coon Joint Replacement Institute in California. His practice focuses on hip and knee joint replacement, including minimally invasive and robotic-arm assisted techniques, and he is a certified national educator for robotic-arm assisted surgery who has trained hundreds of other providers in the technique. Dr. Blackwood received his medical degree from the University of Washington, completed his orthopaedic residency at the University of New Mexico and completed fellowship training at the Coon Joint Replacement Institute. He serves as a surgeon design advisor on Dominion Surgical’s Board of Advisors, and his Boulder practice is one of the Dominion Patient Positioning System training sites.

John Chelena, Dominion Surgical Member Portrait

John Chelena

Vice President of Business Development

John Chelena brings more than 35 years of experience in orthopedic sales, business development, and leadership. He began his career with DePuy, a Johnson & Johnson company, serving as Vice President of Chesapeake Surgical, a DePuy distributorship, where he developed extensive experience across the orthopedic market and built longstanding relationships throughout the surgical community.

John has continued his career in orthopedics as a Smith+Nephew distributor, giving him a unique perspective shaped by decades of working directly with surgeons, healthcare facilities, sales organizations, and industry partners.

As Vice President of Business Development for Dominion Surgical, John brings that experience and network to the company’s commercial expansion. He plays an important role in developing strategic relationships, identifying new market opportunities, and helping introduce the Dominion Patient Positioning System to surgeons and healthcare organizations across the orthopedic community.

John’s deep understanding of the orthopedic marketplace, combined with his trusted industry relationships and practical knowledge of how new technologies gain adoption, makes him an important part of Dominion Surgical’s commercial leadership team.

Karlton Neal, Dominion Surgical Member Portrait

Karlton Neal

Board Advisor

Karlton Neal is a senior healthcare commercial leader with nearly two decades of experience guiding integrated delivery networks, surgical service lines, and perioperative teams through complex capital equipment decisions. His career includes distinguished tenure with Mizuho OSI, where he consistently delivered top-tier performance across competitive territories and played a central role in advancing adoption of specialized surgical positioning technologies in high-acuity environments.

Mr. Neal’s expertise spans enterprise capital sales, IDN strategy, regional market development, and cross-functional operational alignment. He has led major territory expansions, executed multi-hospital system conversions, and produced sustained double-digit growth across the Northeast and Mid-Atlantic regions.

Throughout his career, Mr. Neal has been recognized for his disciplined approach to stakeholder engagement and his ability to translate clinical workflow needs into scalable commercial strategy. He has served as a trusted partner to surgeons, OR directors, supply chain executives, and hospital leadership, advising on product selection, operational efficiency, and long-term capital planning. His contributions extend to national sales training, mentorship of emerging commercial talent, and the development of structured territory activation frameworks.

Mr. Neal brings to Dominion Surgical a deep understanding of surgical positioning ecosystems, perioperative workflow dynamics, and the decision pathways that drive product adoption within complex health systems. His advisory role supports Dominion’s commitment to clinically relevant innovation, operational excellence, and strategic market expansion.

Mr. Neal resides in Eastern Pennsylvania and remains active in his community through youth sports coaching and mentorship.

Helen Dickson, Dominion Surgical Member Portrait

Helen Dickson, MSN, RN, CNOR, RNFA

Board Advisor

Helen Dickson, MSN, RN, CNOR, RNFA is a nationally recognized ambulatory surgery center (ASC) leader, perioperative nursing expert, and healthcare consultant with more than 30 years of experience in orthopedic surgery, surgical services, and ASC operations. She currently serves as CEO of SurgiPath Advisors, providing consulting services for ASC development, operational excellence, accreditation readiness, and orthopedic program optimization.

Helen also serves as Director of ASC Strategy and Optimization for Premier Orthopedics, is President of the Pennsylvania Ambulatory Surgery Association, and is a PRN Surveyor for AAAHC, where she contributes to accreditation and quality improvement initiatives, including Advanced Orthopedic Certification. Throughout her career, she has held leadership roles in clinical operations, nursing education, and perioperative practice while remaining an active educator, national speaker, published author, and peer reviewer. Her passion for advancing ambulatory surgery through operational excellence, regulatory compliance, and evidence-based practice has made her a respected voice in the ASC and perioperative communities.

Conrad Ivie, Dominion Surgical Member Portrait

Conrad Ivie, MD

Surgeon Design Advisor

Conrad Ivie, MD, MBA is a board-certified, fellowship-trained orthopaedic surgeon with Tennessee Orthopaedic Alliance in Knoxville and Lenoir City, Tennessee. His practice focuses on hip and knee preservation and reconstruction, including hip arthroscopy and minimally invasive anterior approach total hip replacement.

Dr. Ivie earned his medical degree at the University of Tennessee Health Science Center, completed his orthopaedic residency at the University of Missouri, and completed a fellowship in adult hip and knee arthroplasty and hip resurfacing at the Anderson Clinic. He is a member of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons, and is founder and CEO of Physicians Capital.

Arjun Saxena, Dominion Surgical Member Portrait

Arjun Saxena, MD

Surgeon Design Advisor

Arjun Saxena, MD, MBA is a fellowship-trained, board-certified orthopaedic surgeon at Rothman Orthopaedic Institute specializing in primary and revision hip and knee replacement, including the direct anterior approach. He serves as Director of the Marjorie C. Ernest Center for Joint Replacement at Capital Health, is Co-Chair of Rothman’s Ambulatory Surgery Committee, and is an Associate Professor of Orthopaedic Surgery at Thomas Jefferson University.

Dr. Saxena earned his medical degree at Sidney Kimmel Medical College of Thomas Jefferson University, completed his orthopaedic residency at Thomas Jefferson University Hospital, and completed an adult hip and knee reconstruction fellowship at the Anderson Orthopaedic Clinic in Alexandria, Virginia. He holds an MBA from Pennsylvania State University and serves on committees of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Eastern Orthopaedic Association.

Zafer Termanini, Dominion Surgical Member Portrait

Zafer Termanini, MD

Inventor and Co-Founder

Dr. Zafer Termanini is the inventor of the Dominion Patient Positioning System and Co-Founder of Dominion Surgical. A board-certified orthopaedic surgeon with more than 30 years of clinical experience, Dr. Termanini has dedicated much of his career to orthopaedic innovation, joint reconstruction, biomechanics and the development of technologies designed to improve surgical care.

Dr. Termanini is a Fellow of the American College of Surgeons and a member of the American Academy of Orthopaedic Surgeons. His clinical and technical background spans orthopaedic and joint reconstruction, sports medicine and biomechanical analysis. He has held multiple U.S. patents and patent applications for medical and orthopaedic innovations, including technologies that have been successfully commercialized.

Throughout his career, Dr. Termanini has combined his experience as a practicing orthopaedic surgeon with a strong interest in engineering and medical device development. That perspective ultimately led to the invention of the Dominion Patient Positioning System, designed to rethink how patient positioning technology can better serve surgeons, operating room staff, healthcare facilities and their patients.

Dr. Termanini received his medical degree, with honors, from the Université d’Angers in France and also studied biomechanical engineering at Arts et Métiers. He has held surgical leadership positions and hospital privileges throughout his career and has practiced in multiple states.

Eric Slotkin, Dominion Surgical Member Portrait

Eric Slotkin, DO

Medical Director

Eric Slotkin, DO is a board-certified orthopaedic surgeon with Orthopaedic Associates of Reading in Wyomissing, Pennsylvania, and serves as Medical Director of Dominion Surgical. His practice focuses on hip, knee and shoulder joint replacement, including minimally invasive direct anterior hip replacement, complex primary and revision hip and knee surgery, and hip preservation.

Dr. Slotkin graduated from the Philadelphia College of Osteopathic Medicine, completed his orthopaedic residency at PinnacleHealth and Penn State Hershey Medical Center, and completed fellowship training in adult reconstruction and joint replacement at the Cleveland Clinic. He has authored peer-reviewed publications and serves as teaching faculty at joint reconstruction courses.

Lon White, Dominion Surgical Member Portrait

Lon White

Chief Commercial Officer

Lon White is a 30-year veteran of the MedTech industry with extensive experience across the musculoskeletal space. Throughout his career, he has built a respected global network and a reputation as someone who understands how to turn innovative technologies into commercial opportunities and, most importantly, how to get things done.

Lon has played critical roles in numerous successful transactions and exits across MedTech and other industries and has helped commercially launch multiple musculoskeletal technology platforms. His experience spans commercialization, go-to-market strategy, business development, strategic partnerships, restructuring, recapitalization, and investment strategy.

As Chief Commercial Officer of Dominion Surgical, Lon brings that experience directly to the company’s commercialization efforts. He is helping shape Dominion’s go-to-market strategy, build and expand key relationships across the orthopedic ecosystem, and guide the company through its transition from product development and clinical evaluation into commercial adoption and growth.

Lon combines an extensive industry network with an entrepreneurial approach to emerging healthcare technologies. His ability to connect strategy with execution makes him an important part of Dominion Surgical’s leadership team as the company introduces a new approach to patient positioning to the orthopedic market.

Albert Nanni, Dominion Surgical Member Portrait

Albert Nanni

CEO & Co-Founder

Albert (“Al”) Nanni is a 32-year orthopedic industry veteran, entrepreneur, and CEO of Dominion Surgical. He is also the Founder of Pivot MedTech and North Medtech Advisors.

Over the course of his career, Al has built a reputation for recognizing important market shifts early and helping bring innovative technologies to market. His experience spans orthopedic distribution, commercialization, business development, surgeon engagement, and strategic growth initiatives across the U.S. and international markets.

Having spent decades working closely with surgeons, healthcare providers, and medical technology companies, Al brings a unique perspective rooted in firsthand operating room experience and real-world market knowledge. He believes that expertise creates confidence, and that the best opportunities emerge when deep industry knowledge is paired with the willingness to take calculated risks.

After founding and building a successful independent medical device distribution business through Pivot MedTech, Al expanded into healthcare business development and commercialization strategy through North Medtech Advisors. Those experiences ultimately led to the creation of Dominion Surgical, where he recognized an opportunity to rethink orthopedic patient positioning and develop a surgeon-controlled platform designed around autonomy, workflow efficiency, and improved patient care.

Today, Al is known for combining deep orthopedic expertise, an extensive national and international network, and a builder’s mindset. His approach has remained consistent throughout his career: stay engaged, understand the market better than anyone else, and be willing to bet on yourself when the opportunity is real.

Al credits much of his success to the unwavering support of his wife, Lynda, their three children, and a faith that has guided him through both opportunities and challenges. While he is passionate about innovation and entrepreneurship, his family remains his greatest accomplishment and daily source of motivation.