DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left knee genu valgum with lateral joint space arthrosis.
POSTOPERATIVE DIAGNOSIS:
Left knee genu valgum with lateral joint space arthrosis.
OPERATIONS PERFORMED:
1. Left knee lateral patellar facetectomy with Biomet Vanguard.
2. Lateral unicondylar arthroplasty with platelet gel and pain pump.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room where general anesthesia was administered. The left leg was prepped and draped routinely. The leg was elevated and exsanguinated, and a tourniquet was inflated to 200 mmHg pressure. The leg was placed over the Stryker leg holder and a 3-inch lateral parapatellar incision was made and carried down through the subcutaneous tissues. Lateral capsular incision was made and the joint was exposed. There was a large lateral patellar spur. This was carefully exposed and removed with a nibbler, performing a lateral patellar facetectomy. The medial side of the joint was visualized, and it was noted that weightbearing on tibia and femur appeared to be intact with no meniscal tears. The notch itself showed that the ACL was intact, but there were spurs encroaching upon it, and there were large lateral condylar spurs. The lateral condylar spurs were left in place with the placement of the femoral component, and the notch spurs were removed using an osteotome. The external tibial guide was applied, lined up, keyed to take about 3 mm in the lowest point of the tibia wear and then the initial sagittal and transverse cuts were made and extended across, removing the bone in the proximal tibia. At this point, the baseplate with a 5 spacer fit, so this was removed. The IM drill was used and IM rod was inserted and then it was measured for a small femoral component. So the baseplate, 4 mm spacer, and a small posterior cutting block were lined up, and the initial drill holes were placed. The extra cutting block was applied, and the posterior femoral cut was made, removing the posterior condylar bone.
Following this, the #0 spigot was inserted, and the initial distal milling was performed. The flexion and extension gaps were checked and the 5 mm baseplate fit in flexion, and the 1 mm baseplate in extension, so the 4 mm spigot was applied and an extra 4 mm of bone was carefully removed. Flexion and extension gaps were then balanced quite well following which the posterior osteophytes were removed. The remaining lateral meniscus was removed, and the initial tibia was measured for a B5 tibia. The keel cut was made for the tibia and trial reduction with a B5 trial, and a small femoral component gave good range of motion and good stability, and then any impinging anterior spurs were then removed at that time. All the components were removed. The joint was thoroughly irrigated. A small pencil bur was used to make drill holes in the femur and tibia for cementation. The joint was thoroughly irrigated. The posterior aspect of the joint was injected with 0.5% Marcaine with epinephrine, and the sponges were packed around the tibia and femur following which the methyl methacrylate was mixed with tobramycin and injected in the femur and tibia, placed on the components. Then the tibial component and femoral component were inserted. The joint was ranged over a blade compressing it and holding it at 45 degrees. Excess cement was removed away. Once the cement had set, there was good range of motion and good stability. No impingement. The joint was thoroughly irrigated, tourniquet was released, and hemostasis was obtained. The medial capsule was closed with #1 Vicryl. The lateral capsule was closed with #1 Vicryl. The subcutaneous layer was closed with #2 Vicryl and skin closed with subcuticular Monocryl suture with Dermabond to the skin. The patient then had a compression dressing, Ace wrap, a knee immobilizer applied, and was moved to the recovery room in good condition. The patient tolerated the procedure well.
