Left anterior total hip arthroplasty
PREOPERATIVE DIAGNOSIS
Left hip degenerative joint disease.
POSTOPERATIVE DIAGNOSIS
Left hip degenerative joint disease.
PROCEDURE
Left anterior total hip arthroplasty.
ANESTHESIA
Spinal.
INDICATION FOR PROCEDURE
This patient is a female with a longstanding history of severe left hip pain. She had failed conservative treatment including cane use, oral anti-inflammatories, cortisone injections, physical therapy. Decision made to proceed forward with treatment.
DESCRIPTION OF PROCEDURE
The patient was met in preoperative area. Operative extremity identified and marked. Informed consent discussed and signed including the risks of, but not limited to, pain, infection, bleeding, weakness, stiffness, numbness, tingling, need for further surgery, leg-length discrepancy, dislocation, loss of limb or life. The patient is aware of this, consented. The patient is taken to the operative theater. Spinal anesthesia given. The patient was sterilely prepped and draped supine on the Hana table. Time-out performed with all personnel. First, an anterior lateral incision was created. This was carried down to the fascia of the TFL, this was incised. The muscle fibers were dissected from the anterior aspect of the fascia. There the underbelly of the rectus femoris muscle was incised with Bovie electrocautery. After this was done, the scarpa's fascia was divided allowing access to the anterior circumflex femoral arteries. These were coagulated with the Aquamantys followed by the Bovie electrocautery. Next, the indirect head of the rectus femoris was incised and the anterior capsule was exposed. A H-flap capsular incision was created for superior and inferior capsular flaps. These were tagged. Next, the neck cut length was marked for 7 mm on fluoroscopic control with the Bovie. This cut was then created with the oscillating saw. Next, the head fragment was removed. Next, we approached the acetabulum, the pulvinar was released. The labrum was excised. Next, sequential reaming starting at a size 46 was done going by 2 mm increments to a size 50 and then to a 51 mm. This was reamed down to the level of the medial wall. Thus a 52 mm gripping cup was selected. This was impacted and approximately 42 degrees of abduction and 15 degrees anteversion based on fluoroscopic measurements. This had excellent fixation. The trial liner was placed. Next, our attention was turned to the femur. The femur was exposed. The superior lateral capsular tissue was excised allowing the rongeur to take some of the saddle area away. Next, the canal finder followed by sequential broaching was done up to a size 13 Corail standard stem. Calcar reamer was used to plant the stem and this was trialed with a plus 1.5 head neck combination. This was seen under fluoroscopic visualization and found to have equal leg lengths with appropriate offset. Stability testing revealed that was stable to 80 degrees external rotation, and extension external rotation to 45 degrees of flexion. Internal rotation produced no instability. The size was then selected. Next, the trial components were removed. The neutral liner was impacted into the cup after irrigating. Next, the size 13 Corail standard stem was impacted into the femoral canal. Under this was impacted a 36 plus 1.5 head and this was relocated. Final x-rays were taken, showing appropriate alignment of components, leg length, and offset. A Betadine wash was irrigated throughout the incision irrigated with 1 L of normal saline. Next, a capsular flaps were closed with interrupted #1 PDS suture followed by a running fascial Quill #2-0 followed by 2-0 Quill on the skin and Dermabond exteriorly. At the end of the procedure, intra-articular was given an injection of 30 mg ketorolac, 1 g tranexamic acid, and 20 cc of 0.25% Marcaine with epinephrine. At the end the procedure, all sponge and instrument counts were correct. The patient was placed into Aquacel dressing and transferred to the gurney safely.
Implants include DePuy Corail standard offset size 13 stem, 36 plus 1.5 head, and a 52 mm cup with neutral liner and a Pinnacle gripping cup.
Left hip degenerative joint disease.
POSTOPERATIVE DIAGNOSIS
Left hip degenerative joint disease.
PROCEDURE
Left anterior total hip arthroplasty.
ANESTHESIA
Spinal.
INDICATION FOR PROCEDURE
This patient is a female with a longstanding history of severe left hip pain. She had failed conservative treatment including cane use, oral anti-inflammatories, cortisone injections, physical therapy. Decision made to proceed forward with treatment.
DESCRIPTION OF PROCEDURE
The patient was met in preoperative area. Operative extremity identified and marked. Informed consent discussed and signed including the risks of, but not limited to, pain, infection, bleeding, weakness, stiffness, numbness, tingling, need for further surgery, leg-length discrepancy, dislocation, loss of limb or life. The patient is aware of this, consented. The patient is taken to the operative theater. Spinal anesthesia given. The patient was sterilely prepped and draped supine on the Hana table. Time-out performed with all personnel. First, an anterior lateral incision was created. This was carried down to the fascia of the TFL, this was incised. The muscle fibers were dissected from the anterior aspect of the fascia. There the underbelly of the rectus femoris muscle was incised with Bovie electrocautery. After this was done, the scarpa's fascia was divided allowing access to the anterior circumflex femoral arteries. These were coagulated with the Aquamantys followed by the Bovie electrocautery. Next, the indirect head of the rectus femoris was incised and the anterior capsule was exposed. A H-flap capsular incision was created for superior and inferior capsular flaps. These were tagged. Next, the neck cut length was marked for 7 mm on fluoroscopic control with the Bovie. This cut was then created with the oscillating saw. Next, the head fragment was removed. Next, we approached the acetabulum, the pulvinar was released. The labrum was excised. Next, sequential reaming starting at a size 46 was done going by 2 mm increments to a size 50 and then to a 51 mm. This was reamed down to the level of the medial wall. Thus a 52 mm gripping cup was selected. This was impacted and approximately 42 degrees of abduction and 15 degrees anteversion based on fluoroscopic measurements. This had excellent fixation. The trial liner was placed. Next, our attention was turned to the femur. The femur was exposed. The superior lateral capsular tissue was excised allowing the rongeur to take some of the saddle area away. Next, the canal finder followed by sequential broaching was done up to a size 13 Corail standard stem. Calcar reamer was used to plant the stem and this was trialed with a plus 1.5 head neck combination. This was seen under fluoroscopic visualization and found to have equal leg lengths with appropriate offset. Stability testing revealed that was stable to 80 degrees external rotation, and extension external rotation to 45 degrees of flexion. Internal rotation produced no instability. The size was then selected. Next, the trial components were removed. The neutral liner was impacted into the cup after irrigating. Next, the size 13 Corail standard stem was impacted into the femoral canal. Under this was impacted a 36 plus 1.5 head and this was relocated. Final x-rays were taken, showing appropriate alignment of components, leg length, and offset. A Betadine wash was irrigated throughout the incision irrigated with 1 L of normal saline. Next, a capsular flaps were closed with interrupted #1 PDS suture followed by a running fascial Quill #2-0 followed by 2-0 Quill on the skin and Dermabond exteriorly. At the end of the procedure, intra-articular was given an injection of 30 mg ketorolac, 1 g tranexamic acid, and 20 cc of 0.25% Marcaine with epinephrine. At the end the procedure, all sponge and instrument counts were correct. The patient was placed into Aquacel dressing and transferred to the gurney safely.
Implants include DePuy Corail standard offset size 13 stem, 36 plus 1.5 head, and a 52 mm cup with neutral liner and a Pinnacle gripping cup.
Your story is really hurtful, anyway it's a good help for others about cortisone injection side effects and bad experience.
ReplyDeleteRegards
Cortisone Injection