DATE OF SURGERY: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left knee medial joint space arthrosis with genu varum.
POSTOPERATIVE DIAGNOSIS:
Left knee medial joint space arthrosis with genu varum.
OPERATION PERFORMED:
Left knee medial patellar facetectomy with Oxford medial unicondylar arthroplasty with platelet gel and pain pump.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
DESCRIPTION OF OPERATION: The patient was brought to the operating room where spinal anesthesia was administered. The left leg was prepped and draped routinely. The leg was elevated and exsanguinated. The tourniquet was inflated to 300 mmHg pressure. The leg was flexed over the Stryker leg holder where a 3 inch medial parapatellar incision was made and carried down to the subcutaneous tissues. A medial capsular incision was made and the joint was exposed. There was increased joint fluid and some mild synovitis. The medial femoral cartilage was worn down to bare bone along the medial border. There was also an area of oblique cartilage loss and bare bone on the medial tibial plateau. The ACL was intact. There was noted to be large lateral and medial osteophytes in the notch. There were medial patellar osteophytes with moderate patellar chondromalacia and medial femoral condylar osteophytes. The lateral joint space could be visualized by placing a Huber across the joint, and it was noted that there was no significant wear or full-thickness erosions in the weightbearing portion of the lateral joint space.
Additionally, a notchplasty was performed in the lateral femoral condyle, in the notch, using small osteotome. The medial patellar facetectomy was performed by using a rongeur and oscillating saw to remove the medial patellar spurs and smoothed off. The medial femoral cartilage was removed with a curved osteotome following which external tibial guide was applied, lined up and then the initial sagittal and transverse cuts made. It was noted that the 3 mm spacer would barely fit in at this point, so following this, it was moved down one hole on the cutting block and a second series of cuts made following which the 4 to 5 mm spacer would fit with the baseplate. Following this, the IM drill was used, IM rod inserted and the cutting block lined up with a baseplate, 4 mm spacer and baseplate and was lined up with the IM rod in the sagittal, coronal and AP planes. The drill holes were placed, posterior femoral cut made for a medial femoral component, following which the initial milling was then performed using the 0-spigot.
Flexion and extension gaps showed that there was a 5 to 6 gap in flexion and a 4 to 5 gap in extension indicating about 1 mm difference, so 1 mm spigot was inserted and one more millimeter was removed from the distal end of the femur, following which there was good flexion and extension gapping. Following this, the anterior cartilage was removed to prevent impingement. The posterior osteophytes were removed. The meniscus was removed and the keel was then cut for a 41 x 28 mm baseplate. A trial reduction with the keel baseplate, 5 mm spacer and the medial femoral component gave good range of motion and good stability.
All components were removed. The joint was thoroughly irrigated. The drill holes were placed in the femur and tibia for cementation. Marcaine with epinephrine was injected into the posterior aspect of the joint. Sponges were packed up around the tibia. The cement with gentamicin carefully mixed, injected under pressure in the tibia and femur, compressed across the tibia where the tibial component and femoral components were inserted. Spacer placed. Excess cement removed and the knee held in 45 degrees until the cement set.
Following this, the tourniquet was released, hemostasis was obtained and any remaining cement fragments were removed. A bone block was placed into the tibial drill hole and femoral drill hole to prevent any bleeding. The actual 5 bearing was then inserted. There was good range of motion and good stability. The wound was thoroughly irrigated, hemostasis obtained. The medial capsule was closed with #1 Vicryl. Subcutaneous layers were closed with 2-0 Vicryl. Platelet gel, pain pump and the cocktail were injected into the knee. Subcutaneous layer was closed with 2-0 Vicryl and the skin closed with staples. Steri-Strips, compression dressing, knee immobilized and the patient was moved to the recovery room in good condition, having tolerated the procedure well.
