DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Avascular necrosis with severe collapse, total head involvement, left hip.
POSTOPERATIVE DIAGNOSIS:
Avascular necrosis with severe collapse, total head involvement, left hip.
OPERATION PERFORMED:
Left total hip arthroplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: This (XX)-year-old male was noted to have progressively worsening hip pain. He was noted to have on x-ray avascular necrosis with severe collapse and loss of sphericity of the femoral head, Ficat grade 4. The risks and benefits of total hip arthroplasty were discussed in detail, and the patient signed surgical consent.
DESCRIPTION OF OPERATION: The surgical site was signed. The patient was prepped and draped in a routine sterile manner. The IV antibiotics were given prior to the procedure. The surgical team used space suits for added sterility. A posterolateral approach to the hip was made. The fascia was identified and split in line of its fibers. The short external rotators were identified. A T-capsulotomy was performed. The hip was dislocated. The femoral neck was cut using a reciprocating saw. The cut was made based on intraoperative and preoperative templating.
Once the neck was cut, the patient’s anteversion was noted, and bone wax was placed on the neck cut to decrease bleeding. The acetabular retractors were placed, a cobra retractor anteriorly, and a posterior-inferior retractor placed into the obturator foramen after an inferior radial capsulotomy. The acetabulum was exposed. The soft tissues, including the labrum and pulvinar, were removed from the acetabulum, and then the acetabulum was progressively reamed from a size 50 up to a size 56. A 57 mm Converge cup was then impacted into place at position of 45 degrees of abduction and 20 degrees of anteversion. The overhanging osteophytes were removed. The 38 mm liner was snapped into the cup. A lap sponge was used to protect the cup.
The acetabular retractors were removed. A proximal femoral retractor was placed. The proximal femur was machined first with a cookie cutter osteotome, then a lateralizing reamer, and then progressive broaches. The broaches were taken up to a size 13.5. This initially had good fit. X-rays were taken with a 13.5 mm stem and a neutral ball.
Of note, intraoperative x-rays did note that there was residual room at the lateral aspect of the femur. This was likely secondary to scarred bone from his prior cord decompression. The trial stem was then removed, and using a large curette, the lateral bone was removed. We then again machined from a size 13.5 up to a size 16.25 stem. The 16.25 had excellent fit, kept the equal leg length at the same level as the intraoperative x-ray, taken with the 13.5, but had better canal fill. The real stem was then placed. A neutral ball was placed.
The hip was then tested for range of motion, noted to be quite stable with flexion to 90 degrees, internal rotation to 70, and no instability with extension, external rotation. The capsule was then repaired with #2 FiberWire. The short external rotators were repaired with #2 FiberWire to the trochanter. The fascia was closed with 0 PDS, the subcutaneous tissue was closed with 0 Vicryl, a running 3-0 Monocryl was placed at the subcuticular region. Dermabond was placed at the skin.
The patient was taken to recovery room in stable condition. Estimated blood loss was 150 mL. Sponge and needle count was correct.
