DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right knee medial compartment degenerative arthritis.
POSTOPERATIVE DIAGNOSIS: Right knee medial compartment degenerative arthritis.
OPERATION PERFORMED:
1. Right knee medial compartment hemiarthroplasty.
2. Partial patella excision.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought into the room and anesthetized with general anesthesia. The right lower extremity was prepared with a tourniquet. The leg was prepped with DuraPrep and draped in a sterile fashion. The limb was exsanguinated. Thigh tourniquet was inflated to 300 mm of pressure.
The patient had an oblique incision over the medial aspect of the knee. We were able to use most of this incision distally. It was curved slightly anterior so that we could gain a full access of the medial compartment. Dissection was carried down through the subcutaneous tissue. The medial retinaculum of the patella was incised, and the incision was carried proximally along the vastus medialis oblique for 2 cm. This revealed the medial compartment with extensive osteoarthritis, medial compartment with eburnated bone on both femur and tibia, large bone spurs on both sides. The patella was thickened and overgrowing medially. We thought that we had to do a partial patella excision so that the patella would not impinge on the implant, so we subperiosteally elevated the medial facet of the patella, and using the oscillating saw, we osteotomized approximately 30% of the medial facet of the patella. The rongeur was used to smooth out the remainder of the patella. At the end of the case, this defect was closed by pulling the periosteal tissues and retinacular tissues over the defect and suturing from medial to lateral.
Next, we approached the proximal tibia and exposed it. We used a tibial cutting guide attached to the proximal tibia. We made the sagittal cut with the reciprocating saw and the transverse cut with the oscillating saw. We sized the flexor space. We used the intramedullary alignment guide. We made the pilot hole for the intramedullary alignment guide. We put the first cutting jig in position using the intramedullary rod for alignment. We anchored the cutting jig in position and we cut the posterior femoral condyle.
Then, we used a second jig. We measured the flexion space and extension space and used the progressively larger spigots. We were able to ream the extension space to match the flexion space. Along the way, we removed the bone spurs circumferentially. Once we had the flexion space and extension spaces matched up, we put the trial components in place.
Once we were happy with the alignment and positioning, we then marked the position for the tibial tray, and we cut the slot for the tibial stem in the usual fashion with the punches and curette. Since the distal femur was eburnated, we made several drill holes in the distal femur. We irrigated the bone. We irrigated the joint. We infiltrated the posterior capsule, PCL, medial capsular structures, and subcutaneous tissues with 0.025% Marcaine. The cement, antibiotics, tobramycin cement was mixed, and we cemented the components in place, first the tibia, then the femur.
Once the cement hardened, we did another trial reduction with 6 mm bearing. This gave us excellent stability. Soft tissue tension was equal in both flexion and extension. The actual bearing was selected. The area was irrigated.
At the beginning of the case, we removed 55 mL of blood from the patient, spun it down to platelet growth factors, and this was applied around the cut tendinous and bony surfaces. A drain was left in place.
The medial retinacular structures were closed with interrupted Vicryl suture closing the defect that was left by removing part of the patella. The deep fascia was closed with interrupted Vicryl suture. The subcutaneous closure was obtained with Vicryl. Skin was closed with staples. Sterile dressing was applied. The patient was awoken and taken to the recovery room in stable condition.
