DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Avascular necrosis of the right femoral head.
POSTOPERATIVE DIAGNOSIS: Avascular necrosis of the right femoral head.
OPERATION PERFORMED: Two-incision total hip replacement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Spinal.
COMPONENTS INSERTED: A DePuy Pinnacle 100 series 54 mm acetabular cup, Pinnacle Marathon acetabular liner +4, 10 degree angle, 32/54 mm. Corail size 14 standard femoral stem, 32 mm, +5 femoral head.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and transferred to the operating table in the supine position, given satisfactory anesthetic. The patient was turned onto the lateral decubitus position and the right hip was prepped and draped in the usual sterile fashion.
The operation was done through a 2-incision approach with 2.5 inches anterior and 2.75 inches posterior incision. The anterior incision was made first. The incision was centered at the vastus ridge of the greater trochanter and the medial border of the tensor fascia latae. The incision was carried through the skin and subcutaneous tissue. The fascia between the sartorius and the TFL was separated and then the interval between the vastus lateralis and the rectus femoris was developed down to the anterior hip capsule. Branches of the lateral femoral circumflex artery were controlled with cautery. The reflected head of rectus was released and then an anterior capsulectomy was carried out. Osteophytes from the anterior wall and the anterior labrum were removed.
Next, the posterior incision was made 2 fingerbreadths posterior and distal to the tip of the greater trochanter. The incision was carried through skin and subcutaneous tissue and the fascia and fibers of the gluteus maximus were divided in line with the incision. The posterolateral corner of the greater trochanter and the gluteus medius was identified and then the bursa was removed. Using electrocautery, a musculocapsular flap of the piriformis, obturators, gemelli and posterior capsule was released from the back of the trochanter sparing the quadratus. The hip was internally rotated and dislocated posteriorly. The femoral head and neck were osteotomized and removed. The medullary canal of the femur was opened up with a blunt canal finder and then the proximal femur was prepared with sequential impaction broaches up to the femoral stem size.
Attention was turned anteriorly. The remainder of the acetabular labrum, transverse ligament and ligamentum teres was removed. The socket was reamed with hemispherical reamers 1 mm less then the cup diameter and then a porous cup was press fit in satisfactory position, 6.5 mm self-tapping screws were predrilled and placed through the shell. The polyethylene liner was impacted into the shell.
From the back, the trial femoral stem and head was inserted and the hip reduced. The leg length, ROM and stability were excellent. The hip was dislocated, the trial removed and the HA coated femoral stem was press fit into the prepared canal. The femoral head was applied and the hip reduced.
The wounds were irrigated and a deep drain was placed. The joint space was flooded with 0.5% Marcaine with epinephrine through the drain. The fascia of the gluteus maximus was closed with #1 PDS as was the anterior interval between the rectus and TFL avoiding the lateral femoral cutaneous nerve in the superficial fascia. The subcutaneous tissue was sprayed with topical thrombin and closed with multiple layers of 2-0 Monocryl, 3-0 Monocryl and the skin with Steri-Strips.
A dressing was applied with Kerlix antimicrobial gauze. The patient was taken to the recovery room in satisfactory condition having tolerated the procedure well. The patient received a gram of cefazolin and a gram of vancomycin IV at the start of the procedure.
