Total knee arthroplasty
PREOPERATIVE DIAGNOSIS
Right knee degenerative joint disease.
POSTOPERATIVE DIAGNOSIS
Right knee degenerative joint disease.
PROCEDURE
Right total knee arthroplasty.
ANESTHESIA
General with femoral block.
INDICATIONS FOR THE PROCEDURE
This patient is a female with a longstanding history of severe right knee pain. She had failed conservative treatment including cortisone injections, oral anti-inflammatories, physical therapy, and bracing. Because of this, decision was made to proceed forward with surgery.
DESCRIPTION OF PROCEDURE
Patient was met in the preoperative area. The operative extremity was identified and marked. Informed consent was discussed and signed. The patient was then taken to the operative theater, general anesthesia was given. The patient was sterilely prepped and anesthetized. Time-out was performed with all personnel. Tourniquet was not inflated. First, an anterior incision was created. A medial parapatellar arthrotomy was created.
Next, the offset was measured to be 13 mm of the worn medial femoral condyle at 90 degrees of knee flexion.
Next, the osteophytes were removed off the medial and lateral femoral condyles. The ACL was resected. The patella was everted. This was sized to 22-mm thickness. This was cut down to 12-mm thickness. Some of the fat pad was resected as well as the anterior portion of the lateral meniscus.
Next, the intramedullary alignment rod was placed in the femur and the one-on-one paddle was placed over the distal femur. These cuts were created yielding a 6-mm thickness cut on the medial distal femur and a 9-mm thickness lateral with unworn surface.
Next, the femoral rotation guide was placed. This was used to measure a size 8 femur. These drill holes were then created in 0 degrees of rotation. A 1-mm spacer washer was placed into the lateral post of the four-in-one guide due to the 1 mm resection on the lateral side. This was held in place and the distal femoral cuts were created. This yielded an 8-mm distal lateral cut and then a 7-mm distal medial cut. Thus, this guide was removed. The medial hole was anteriorized 1 mm. It was re-pinned. This cut was recreated on the posterior surface to remove one more millimeter off the posteromedial and femoral condyle. After this, the remaining anterior and chamfer cuts were created. There was no notching.
Next, our attention was turned to the tibia. The alignment of the lateral compartment was marked with two drill holes and a marker.
Next, the extramedullary alignment guide was placed at the appropriate slope as judged by the using the ________. This created a 10-mm resection off the unworn lateral side. After this was done, the lamina spreader was used to remove posterior osteophytes off the femur as well as the residual of the menisci medially and laterally. After this was done, the 19-mm extension block was used to determine that the gaps were equalized and the limb alignment was equalized as well.
Next, we pinned the tibial tray and placed trial components with a 35-mm trial patella. The offset was measured to be 9 mm. Anterior-posterior stability was good. Extension stability was very good. Flexion and medial lateral stability were very good, as well as rotational stability.
Next, the femur and the tibia were drilled and punched, and these bony surfaces were copiously irrigated with pulsatile lavage. A bone plug was placed in the femoral canal.
Next, the cement was used both on the undersurface of the components as well as the bony surface to cement first the tibial component, then the femoral, and then the patellar component. Excess cement was removed at each step. A 10-mm CR insert was placed and this was allowed to fully harden. After this had been done, a Betadine wash was irrigated throughout the knee, allowed to stand for 3 minutes and irrigated with pulsatile lavage. Final arc of motion was from 0-130 degrees with good patellar tracking with the hands-off technique using gravity only to flex the knee. After this was done, the arthrotomy was closed with interrupted #1 PDS suture, followed by a running #2 Quill suture. An intra-articular injection of 30 mg ketorolac, 1 g tranexamic acid, and 20 cc of 0.25% Marcaine was given intra-articularly. The skin was closed with a running 0 Quill, 2-0 Quill, Dermabond exteriorly, Aquacel dressing, Webril, and Ace wrap. At the end of the procedure, all sponge and instrument counts were correct. The patient tolerated the procedure well.
Implants include Zimmer Persona size 8 narrow femur, size E tibia, 10-mm CR insert, and 35-mm patella.
Right knee degenerative joint disease.
POSTOPERATIVE DIAGNOSIS
Right knee degenerative joint disease.
PROCEDURE
Right total knee arthroplasty.
ANESTHESIA
General with femoral block.
INDICATIONS FOR THE PROCEDURE
This patient is a female with a longstanding history of severe right knee pain. She had failed conservative treatment including cortisone injections, oral anti-inflammatories, physical therapy, and bracing. Because of this, decision was made to proceed forward with surgery.
DESCRIPTION OF PROCEDURE
Patient was met in the preoperative area. The operative extremity was identified and marked. Informed consent was discussed and signed. The patient was then taken to the operative theater, general anesthesia was given. The patient was sterilely prepped and anesthetized. Time-out was performed with all personnel. Tourniquet was not inflated. First, an anterior incision was created. A medial parapatellar arthrotomy was created.
Next, the offset was measured to be 13 mm of the worn medial femoral condyle at 90 degrees of knee flexion.
Next, the osteophytes were removed off the medial and lateral femoral condyles. The ACL was resected. The patella was everted. This was sized to 22-mm thickness. This was cut down to 12-mm thickness. Some of the fat pad was resected as well as the anterior portion of the lateral meniscus.
Next, the intramedullary alignment rod was placed in the femur and the one-on-one paddle was placed over the distal femur. These cuts were created yielding a 6-mm thickness cut on the medial distal femur and a 9-mm thickness lateral with unworn surface.
Next, the femoral rotation guide was placed. This was used to measure a size 8 femur. These drill holes were then created in 0 degrees of rotation. A 1-mm spacer washer was placed into the lateral post of the four-in-one guide due to the 1 mm resection on the lateral side. This was held in place and the distal femoral cuts were created. This yielded an 8-mm distal lateral cut and then a 7-mm distal medial cut. Thus, this guide was removed. The medial hole was anteriorized 1 mm. It was re-pinned. This cut was recreated on the posterior surface to remove one more millimeter off the posteromedial and femoral condyle. After this, the remaining anterior and chamfer cuts were created. There was no notching.
Next, our attention was turned to the tibia. The alignment of the lateral compartment was marked with two drill holes and a marker.
Next, the extramedullary alignment guide was placed at the appropriate slope as judged by the using the ________. This created a 10-mm resection off the unworn lateral side. After this was done, the lamina spreader was used to remove posterior osteophytes off the femur as well as the residual of the menisci medially and laterally. After this was done, the 19-mm extension block was used to determine that the gaps were equalized and the limb alignment was equalized as well.
Next, we pinned the tibial tray and placed trial components with a 35-mm trial patella. The offset was measured to be 9 mm. Anterior-posterior stability was good. Extension stability was very good. Flexion and medial lateral stability were very good, as well as rotational stability.
Next, the femur and the tibia were drilled and punched, and these bony surfaces were copiously irrigated with pulsatile lavage. A bone plug was placed in the femoral canal.
Next, the cement was used both on the undersurface of the components as well as the bony surface to cement first the tibial component, then the femoral, and then the patellar component. Excess cement was removed at each step. A 10-mm CR insert was placed and this was allowed to fully harden. After this had been done, a Betadine wash was irrigated throughout the knee, allowed to stand for 3 minutes and irrigated with pulsatile lavage. Final arc of motion was from 0-130 degrees with good patellar tracking with the hands-off technique using gravity only to flex the knee. After this was done, the arthrotomy was closed with interrupted #1 PDS suture, followed by a running #2 Quill suture. An intra-articular injection of 30 mg ketorolac, 1 g tranexamic acid, and 20 cc of 0.25% Marcaine was given intra-articularly. The skin was closed with a running 0 Quill, 2-0 Quill, Dermabond exteriorly, Aquacel dressing, Webril, and Ace wrap. At the end of the procedure, all sponge and instrument counts were correct. The patient tolerated the procedure well.
Implants include Zimmer Persona size 8 narrow femur, size E tibia, 10-mm CR insert, and 35-mm patella.
Comments
Post a Comment