DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left shoulder degenerative osteoarthropathy.
POSTOPERATIVE DIAGNOSIS: Left shoulder degenerative osteoarthropathy.
OPERATIONS PERFORMED:
1. Left shoulder hemiarthroplasty.
2. Left shoulder glenoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal, supplemental scalene.
TOURNIQUET TIME: None.
ESTIMATED BLOOD LOSS: 100 mL.
DRAINS: None.
COMPLICATIONS: None.
INDICATION FOR OPERATION: This is a (XX)-year-old Hispanic male who was evaluated in the office in regards to progressive left shoulder pain. The patient is having difficulty now with activities of daily living. After a detailed history, physical exam, and review of plain film radiographs concerns of a left shoulder degenerative osteoarthropathy was entertained. Because of continued pain complaints despite corticosteroid injections and after being cleared by Anesthesia as well as his Internal Medicine team, the patient presents now for the above-mentioned operation.
DESCRIPTION OF OPERATION: The patient was taken to the operating room, and after scalene was administered by the anesthesia team, the patient was positioned on the operating room table in a modified beach-chair position. Next, the patient underwent general endotracheal anesthesia by the anesthesia team. Of note, preoperative antibiotics were given. The left shoulder was prescrubbed with Betadine.
Next, the left upper extremity, including the left base of the neck and shoulder, was prepped and draped in the usual sterile fashion. After bony palpation, a longitudinal skin incision was made over the anterior aspect of the left shoulder. Subcutaneous tissue was dissected and hemostasis obtained with electrocautery. The deltopectoral interval was identified. There was really a small cephalic vein, which was almost negligent. Deep dissection was carried down through the deltopectoral interval. The clavipectoral fascia was identified, split in line with the original skin incision. A deep retractor was placed in the wound to help with exposure. The subscapularis tendon was identified and split with a formal tenotomy. Approximately, a 1.5 cm cuff was left laterally. Medial edge was tagged with #2 FiberWire in a Mason-Allen fashion. This was used for repair at the end of the case. Significant amounts of degenerative changes were noted on the humeral head.
A large osteophyte was also noted inferiorly. A 25-degree retroverted proximal humerus cut was then performed with an oscillating saw. Subscapularis was then mobilized to help with the closure at the end of the case. The glenoid was identified, which demonstrated significant erosive changes centrally. A complete labrectomy was performed as well as freeing the capsule to help with mobilization. The glenoid was then reamed with a large reamer to perform a formal glenoplasty. Due to the quality of the rotator cuff, which demonstrated significant fatty infiltration and fraying and thinning, it was felt that no formal glenoid would be needed and this was in fear of causing early loosening. The wound was then liberally irrigated with bacitracin solution under power irrigation.
The attention was then returned back to the proximal humerus. This was reamed and broached to accommodate a 14 mm stem. A 14 mm press-fit stem was then tapped into position. After trial, it was noted that a 54 x 22 humeral head would be used. This was then tapped into place. This demonstrated good bony contact of the humerus with 5 mm overhanging the greater tuberosity. There was 50 degrees anterior and posterior translation as well as 30 degrees 50% anterior and posterior translation, as well as 30% inferior translation.
The wound was again liberally irrigated with bacitracin solution under power irrigation. The subscapularis was then repaired with the #2 FiberWire. The deltopectoral interval was then closed with 2-0 Vicryl in a simple interrupted fashion. The subcutaneous tissue was closed with 2-0 Vicryl in a simple interrupted fashion, and the skin was closed with 3-0 Monocryl in a running subcuticular pull-out stitch. All sponge and instrument counts proved to be correct and estimated blood loss was 100 mL. The wound was then cleaned, steri-stripped and dressed under the sterile field. A Polar Care ice machine and a shoulder immobilizer were placed to the left upper extremity. The patient was extubated in the operating room and transported to the recovery room in stable condition. Exam in the recovery room revealed the patient was neurovascularly intact despite the scalene catheter.
