DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Degenerative joint disease of the left knee.
POSTOPERATIVE DIAGNOSIS: Degenerative joint disease of the left knee.
OPERATION PERFORMED: Left total knee replacement.
SURGEON: John Doe, MD
ANESTHESIA: Epidural.
TOURNIQUET TIME: 50 minutes.
COMPONENTS INSERTED: DePuy PFC Sigma size 5 cruciate-retaining femoral component, size 5 Porocoat mobile bearing tibial tray cemented in hybrid fashion, size 5/12.5 mm rotating platform curved tibial insert, 41 mm 3-peg oval dome patella component.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and transferred to the operating table in the supine position. Epidural anesthetic was administered. A pneumatic tourniquet was applied high on the left thigh, and the left leg was prepped and draped in the usual sterile fashion. The leg was elevated, exsanguinated, and the tourniquet inflated at 300 mm Hg pressure.
A curvilinear anteromedial longitudinal incision was made through skin and subcutaneous tissue. A medial arthrotomy with a midvastus split was developed. The patella was dislocated laterally revealing end-stage arthritis in the knee. Remnants of the medial and lateral menisci, ACL, and the patella fat pads were excised. Osteophytes were debrided globally, including the posterior femoral condyles. A soft tissue release was done of the proximal and medial tibia to balance the knee.
Next, the patellofemoral ligament was released, and an internal lateral retinacular release was done off the inverted lateral patella. The patella height was measured, and the appropriate amount of patella cartilage and bone was removed for the thickness of the specific patellar component. Three fixation holes were made, and a protective patellar cap was applied until cementation.
Next, a drill hole was made in the intercondylar notch of the femur, and an IM rod was inserted for alignment. The distal femoral resection guide was secured to the anterior femoral condyle in 5 degrees of valgus with pins, and 10 mm of distal femoral cartilage and bone was removed. The sizing guide was placed on the distal femoral surface, adjusted to the correct femoral component rotation, and the size marked with drill holes in 3 degrees of external rotation.
Next, the anterior and posterior femoral condyle cuts and chamfer cuts were made with the size-specific cutting blocks. The intercondylar drill hole was plugged with bone graft from resected femoral bone. Following this, an extramedullary tibial alignment guide was set up in neutral varus-valgus and 3 degrees of posterior slope. The PCL was recessed from the tibial intercondylar notch, and surrounding osteophytes were removed. The proximal tibia was cut at the level of the sclerotic medial plateau, preserving the PCL.
Next, the resected tibial plateau was sized, and the size-specific central post hole and keel slots were cut in the upper tibia in the correct rotation. Trials were inserted, including the tibial spacer. The range of motion and stability was satisfactory. The trials were removed. Sclerotic tibial bone was drilled. The bone ends were cleansed with jet lavage.
All components were cemented simultaneously. The knee was held in extension with axial compression until the cement hardened. The porous tibial component was cemented in hybrid fashion with cement on the plateau but not in the central post hole or key holes or around the implant. Excess cement was then removed and the tourniquet deflated. Hemostasis was obtained, and a deep drain was placed and secured with a skin suture. The knee was cleansed with jet lavage, and the real polyethylene rotating platform tibial insert was placed into the tibial component. The tibia was then reduced underneath the femoral component. The range of motion and stability was again checked and was satisfactory. There was no spin-out of the RP insert. The patella tracked true with no-thumbs technique.
The knee was flexed, and the medial arthrotomy was closed in flexion with #1 PDS. The subcutaneous tissue was sprayed with topical thrombin and closed in layers in flexion with 2-0 Monocryl and Steri-Strips. Xeroform gauze and sterile electrodes were placed over the VMO and VL muscles. A bulky Kerlix AMD dressing was applied. The patient was then taken to the recovery room in satisfactory condition having tolerated the procedure well. The patient received 1 gram of cefazolin and 1 gram of vancomycin at the start of the procedure.
