PREOPERATIVE DIAGNOSIS:
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POSTOPERATIVE DIAGNOSIS:
??
POSTOPERATIVE CONDITION:
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TITLE OF PROCEDURE:
TOTAL KNEE REPLACEMENT
PROCEDURE:
The patient was brought to the operating room and was given a ?? anesthesia. A
tourniquet was placed on the proximal thigh and the operative leg was prepped and draped
in the usual sterile technique and the patient received preoperative antibiotics.
The tourniquet was inflated to 350mm of mercury and a longitudinal incision made over the
anterior aspect of the knee and a median parapatellar arthrotomy was performed. There
were extensive degenerative changes in the knee joint. Drill holes were then made in the
distal femur and the tibial plateau. The intramedullary guide was then placed into the femur
with a 5 degree valgus correction and the femoral cutting jig was put in place and our cuts
were made. We then placed an intramedullary rod into the tibia and the tibial plateau was
resected to the appropriate level with an oscillating saw. The articular surface of the patella
was resected with a counter sinking drill and following this final drill holes were made in the
tibia and the patella.
At this point a trial reduction was performed and we had satisfactory range of motion,
alignment and stability in the knee. A lateral retinacular release ? required for satisfactory
tracking of the patella.
At this point, all the trial components were removed and we then irrigated the wound
copiously using Simpulse lavage and filled the joint surface of the tibia and the patella with
methyl methacrylate cement under pressure, following this I impacted a stemmed tibial
plate and polyethylene patella. Cement was allowed to harden and excess cement was
removed. Following this I impacted a femoral component ? methyl methacrylate cement.
I then inserted a polyethylene tibial plateau. The knee was found to have full extension and
flexion and excellent alignment and stability. The tourniquet was let down and hemostasis
obtained. The wound was again irrigated with antibiotic solution and a large Consta-vac
drain was placed in the wound. The fascia was closed with #1 Vicryl sutures, the
subcutaneous tissue closed with 2-0 Vicryl sutures and the skin was closed with staples.
Vaseline gauze and sterile dressings were applied along with an ace wrap. The patient
tolerated the procedure well and was returned to the recovery room in satisfactory
condition.