DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Degenerative joint disease of both knees.
POSTOPERATIVE DIAGNOSIS: Degenerative joint disease of both knees.
OPERATION PERFORMED: Bilateral total knee replacement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Epidural.
TOURNIQUET TIME: Was 46 minutes, right knee; 44 minutes, left knee.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and transferred to the operating table in the supine position, given satisfactory epidural anesthetic. Pneumatic tourniquets were applied high on both thighs. Both legs were prepped and draped in the usual sterile fashion. The left leg was done first and the right sequentially. The components inserted were identical, except for the thickness of the tibial insert. The procedure as done on the left will be described.
The left leg was elevated, exsanguinated, and the tourniquet inflated to 250 mmHg pressure. A curvilinear anteromedial longitudinal incision was made through the skin and subcutaneous tissue. A medial arthrotomy with a midvastus split was developed. The patella was dislocated laterally, revealing severe end-stage arthritis. Remnants of the medial and lateral menisci, ACL, and patella fat pads were removed. Osteophytes were debrided extensively globally. A soft tissue release was done off the proximal medial tibia to balance the knee. The patellofemoral ligaments were released. An internal lateral retinacular release was done off the lateral patellar facet. The patella height was measured, 10 mm of cartilage and bone were removed, 3 fixation holes were made, and a protective patellar cap was applied.
Next, a drill hole was made in the intercondylar notch of the femur. An IM rod was inserted for alignment. The distal femoral resection jig was secured to the anterior femur in 5 degrees of valgus, and the distal femur was resected. Next, the anterior and posterior femoral condyle cuts and chamfer cuts were made with size 4 cutting blocks.
An extramedullary tibial alignment guide was then set up in neutral, varus, valgus, 5 degrees of posterior slope, and the proximal tibia was resected, preserving the PCL. A central post hole and keel slots were cut in the upper tibia in appropriate rotation. Trial components were inserted. The range of motion and stability was excellent and the trials were removed. The bone ends were Water-Pik’d and dried. All components were cemented simultaneously. The knee was held in extension with axial compression until the cement hardened. Excess cement was then removed. Following this, once the cement had hardened, excess cement was removed. The tourniquet was deflated after 44 minutes on the left. Hemostasis was obtained and a deep drain was placed. The tibia was reduced underneath the femoral condyles. The knee was cleansed with a Water-Pik. The medial arthrotomy was closed with #1 PDS. The subcutaneous tissues were sprayed with topical thrombin and closed with multiple layers of 2-0 Monocryl and Steri-Strips. A bulky dressing was applied.
Attention was then turned to the right knee. The right knee incision, arthroplasty, and closure was identical to that on the left, including size of components inserted except for the thickness of the tibial component.
Once the right knee wound had been closed and dressings applied, the patient was taken to the recovery room is satisfactory condition, having tolerated the procedure well. He received 1 gram of Kefzol and 1 gram of vancomycin at the start of the procedure.
