DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Failed patellar component, right knee.
POSTOPERATIVE DIAGNOSIS:
Failed patellar component, right knee.
OPERATION PERFORMED:
Revision of patellar component and right knee replacement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
TOURNIQUET TIME: 20 minutes.
SPECIMENS: None.
DRAINS: None.
CONDITION: To the recovery room in stable condition.
INDICATIONS FOR OPERATION: This is a (XX)-year-old male status post right knee replacement with evidence of a failed and loosened right knee patellar component. The pros, cons, risks and benefits of revision of the patella were discussed. The patient understood that the risks included, but were not limited to infection, phlebitis, anesthetic risks, incomplete relief of symptoms, stiffness, weakness, wound healing problems, malalignment of fracture, blood loss requiring transfusion. The patient underwent a full preoperative including medical and cardiology clearance.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position. After adequate general anesthesia was administered, the patient received 600 mg of IV clindamycin. The proximal thigh tourniquet was applied. The right lower extremity was shaved, prepped and draped in the usual meticulous sterile fashion for lower extremity surgery and then wheeled in where the surgeon and surgical staff were dressed in space suits to reduce the risk of contamination. Further prepping and draping was performed.
The leg was elevated and flexed and an anterior midline incision was made through the old scar using about three-fourth of the old incision. Skin and subcutaneous tissues were incised. Hemostasis was meticulously obtained. Care was taken to maintain thick flaps. A medial parapatellar incision was performed thus revealing the intra-articular aspect of the knee. There was minimal swelling and the patellar component was immediately visualized. It was noted that it had not loosened but actually sheared off its pegs and the pegs remained solidly fixed in the patellar bone.
At this point, the wounds were copiously irrigated. There was a little synovitis but no evidence of infection. Cultures were not obtained. At this point, the patella was recut removing about 2 mm off of the patellar bone and then redrilled. A central peg was applied with a 35 mm patella. The wound was irrigated and dried and the cement was mixed and pressurized to expose the bony surfaces. The final patellar component was then applied and held in place until the cement was completely hard. Once hard, the tourniquet was deflated. Hemostasis was obtained. Minimal bleeding was encountered.
Then, #1 Vicryl figure-of-eight interrupted sutures were used to reapproximate the fascial layer, 2-0 Vicryl interrupted sutures to reapproximate the subcutaneous tissues and staples to reapproximate the skin. Xeroform, 4 x 4s, Webril, Ace bandage from the tips of the toes to the groin completed sterile dressing. There were no intraoperative or immediate postoperative complications. The prognosis is excellent.
