PREOPERATIVE DIAGNOSIS: Left knee degenerative joint disease.
POSTOPERATIVE DIAGNOSIS: Left knee degenerative joint disease.
OPERATION PERFORMED: Left total knee arthroplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 50 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: Once consent was obtained, the patient was given preoperative antibiotics based on his allergy profile and then he was brought to the operative theater by the anesthesia team and anesthetized in the usual fashion. A well-padded tourniquet was placed on the left proximal thigh and then the left lower extremity was prepped and draped in sterile fashion. After Esmarch exsanguination, the tourniquet was inflated and a midline incision was made followed by a medial parapatellar incision and eversion of the patella. Visualization of the distal femur with distal femoral intramedullary guide placed in the appropriate position and then a 5 degree valgus cut was made on the distal femur, resecting 9.5 mm of bone. This was followed by sizing the femur, which was a size 6, and placement of the size 6 distal femoral cutting guide and then the anterior-posterior cuts were made followed by the chamfer cuts.
Once this was completed, the size 6 distal femoral trial was inserted with excellent fit. The posterior cruciate ligament retractor was inserted. The proximal tibia was retracted. The patient’s patellar tendon was intact. Once the proximal tibia was exposed, extramedullary proximal tibial guide was placed and 9 mm was taken off the lateral side on this varus osteoarthritic patient. Once this was done, a size 4 tray was pinned into place. A drop rod was placed down the front of the tibial tray and found to go right down the tibia, indicating no varus-valgus malalignment. The tibial tray was found to be in good position. A 9 mm trial insert was placed and the knee was reduced. There was full extension, greater than 120 degrees of flexion, with no excess varus-valgus or anterior-posterior instability.
Once this was completed, the patella was resurfaced using the appropriate patellar resurfacing guides and then the patellar surface was peg drilled and a 38 mm tri-peg patellar component was inserted and reduced into the trochlea. The knee was brought through a full range of motion. There was no instability of the patella. There was slight lateral patellar tracking. A lateral release was performed. All components were then removed. The proximal tibia was punched. All bony surfaces were copiously irrigated with normal saline, pulsatile lavage and then dried. Then, the tibial component was cemented into place followed by cementation of the patellar component and finally cementation of the Oxinium distal femoral component polyethylene 9 mm insert, was placed, and the cement was allowed to dry. Once the cement was dry, the knee was brought through full range of motion. There was no instability. There was full range of motion and excellent patellofemoral tracking. The excess cement had been removed prior to drying. The components and soft tissue were copiously irrigated with normal saline and the medial parapatellar incision was closed with Ethibond interrupted figure-of-eight sutures.
The Hemovac drain was inserted prior to closure for postoperative swelling control. The subcutaneous layer was closed with Vicryl in interrupted inverted mattress sutures and the skin was approximated with staples. The wound was cleansed and dressed using Adaptic, 4 x 4s, ABD, Webril, Polar Care pack and Ace bandage followed by a knee immobilizer. The tourniquet was deflated prior to dressing placement. There was no excessive bleeding. Toes were pink and warm with excellent capillary refill and pulses. The patient was awakened by the anesthesia team, extubated, and moved to the postanesthesia care unit in stable condition. There were no complications.
