DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Avascular necrosis, right hip.
POSTOPERATIVE DIAGNOSIS: Avascular necrosis, right hip.
OPERATION PERFORMED: Right total hip arthroplasty.
SURGEON: John Doe, MD
INDICATIONS FOR OPERATION: The patient presents for hip arthroplasty having failed nonoperative treatment options. The risks, benefits, and treatment alternatives were discussed including, but not limited to, infection, bleeding, blood clots, nerve injury, dislocation, leg length inequality, prosthetic wear, loosening, need for further surgery, failure to relieve pain, etc. The patient’s questions were answered, and the surgical plan was approved.
DESCRIPTION OF OPERATION: The patient was taken into the operating room, the appropriate extremity was identified, and the patient was positioned with appropriate padding to all pressure areas. After sterile skin preparation and draping, a posterior incision was performed. The skin and subcutaneous tissues were divided to the level of the fascia, which was then incised along the course of its fibers for a posterior approach. Leg lengths were measured prior to dislocation and then the hip capsule was excised, and a femoral neck cut was made. The acetabulum was then exposed and examined. No significant osteophytes were found. No significant acetabular defect was found.
The acetabulum was prepared. The last reamer used was 51 mm. No bone graft was used to reconstruct the acetabular defect. The acetabular component, 52 mm Pinnacle, was positioned appropriately and impacted into position, and mechanical stability was achieved. Supplemental screw fixation was not used. A neutral 36 liner was then appropriately chosen and positioned and the device assembled. Femoral exposure was obtained and the femoral canal was prepared. A trial reduction was performed and hip stability was assessed.
After the appropriate component position was determined, final canal preparation was completed. The component was then impacted into position, and mechanical stability was achieved. A trial reduction was performed, leg length and hip stability were assessed, and the appropriate neck length was chosen, and a +8.5 ceramic head was impacted into position. The final reduction was performed, and hip stability was assessed. The hip was stable to 90 degrees of internal rotation, 20 degrees of abduction, 20 degrees of extension, 20 degrees of adduction, and 60 degrees of external rotation really with no tendency to dislocate.
The wound was irrigated profusely, a final inspection was performed, and bleeding was controlled and the wound was closed in layers. The hip capsule was not sutured. A drain was not placed. Sterile dressings were applied, and a radiograph was ordered. The components were found to be in appropriate alignment. The plan is for a routine postoperative course with weightbearing as tolerated and ambulation. Sciatic nerve was explored at the end of the procedure and found to be intact.
