DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Severe osteoarthritis of the right knee.
POSTOPERATIVE DIAGNOSIS: Severe osteoarthritis of the right knee.
OPERATION PERFORMED: Cemented right total knee replacement.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 100 mL.
DESCRIPTION OF PROCEDURE: In the supine position, general anesthesia was administered. The right knee was prepped and draped. Upper thigh tourniquet was inflated to 250 mmHg. A longitudinal anterior incision was made with #10 blade, was carried through the skin and subcutaneous tissue. A curvilinear anteromedial capsulotomy was made and the patella was everted. A medial release was carried out with a Cobb elevator and cautery over the medial tibial flare. The suprapatellar fat pad was resected. The knee was flexed to past 90 degrees. Multiple loose bodies, the largest measuring over 3 cm in greatest length, were removed. A guidewire was placed up the intramedullary canal of the femur. Distal femoral osteotomy was made with the oscillating saw using Bodnar retractors to protect the MCL and LCL. The second femoral cutting block was placed and the posterior, anterior, and chamfer cuts were made.
Attention was directed to the tibia. A PCL retractor was placed. Intramedullary guidewire was placed down the tibial shaft. The tibial cutting block was placed and osteotomy performed. Trial tibial and femoral components were then placed, as was the trial 10 mm spacer with a PCL stabilizer after removal of the ACL and PCL. Extension 0, flexion past 130 degrees with appropriate balancing. The knee was flexed to 90 degrees. Posterior femoral osteophytes were removed with the curved osteotome and loose bodies removed with the pituitary rongeurs. Posterior capsular release was performed with the Cobb elevator. The patellar osteotomy was then performed and trial 13 mm patellar component placed. Patellar tracking was normal.
All trial components were removed and the knee was irrigated with antibiotic solution using pulsatile lavage. The methyl methacrylate bone cement in semiviscous state was applied to the proximal tibia and the tibial component was inserted and excess cement removed. In a similar fashion, methyl methacrylate bone cement was applied to the distal femur and the femoral component cemented and excess cement removed. A trial of 10 mm tibial insert was placed and the knee was extended. The femoral component was cemented and held in place with a patellar clamp. After all cement hardened, the 10 mm tibial insert with PCL stabilizer was placed and the knee was taken through range of motion. Extension 0, flexion greater than 130 degrees. Ligament stability and balancing was satisfactory. After tourniquet was released, all obvious bleeding vessels were coagulated. The capsule was approximated with 0 Vicryl, subcutaneous tissue with 2-0 Vicryl, and skin with staples. A Jones compression dressing was applied. The patient’s basic postoperative plan will be for physical and occupational therapy and discharge planning.
