DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left hip osteoarthritis.
POSTOPERATIVE DIAGNOSIS: Left hip osteoarthritis.
PROCEDURE PERFORMED: Left total hip arthroplasty using Stryker implants.
SURGEON: John Doe, MD
BLOOD LOSS: 300 mL.
ANESTHESIA: Epidural and general.
IMPLANTS: Stryker Trident PSL HA acetabular shell, size 52 mm, with a 0-degree polyethylene insert from Trident. We used the +5, 36 mm femoral head and the Secur-Fit Plus Max femoral stem. Two cancellous bone screws were also used in the acetabular shell.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old with progressively worsening left-sided hip pain adversely affecting the quality of life and not responding to conservative care. Clinical examination demonstrated severe Trendelenburg limp, painful range of motion of the left hip. Radiographs demonstrate significant degenerative changes present. She was felt to be a candidate for total hip arthroplasty. She was informed of risks and benefits of the procedure, including the risk of infection, possibility of implant removal, stiffness, fracture, nerve or blood vessel injury, blood clot, pulmonary embolism and medical complications were discussed. The patient signed informed consent for left total hip arthroplasty.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room where the anesthetic was administered. A Foley catheter was placed and she received the IV antibiotics. She was then rolled into the right lateral decubitus position, held in position with a padded clamp, and her dependent side was carefully padded with an axillary roll.
The left lower extremity was then scrubbed and draped in the usual fashion. We did a posterolateral skin incision, dissected down through the skin and subcutaneous fat to the fascia. The fascia was incised in line with the incision. We placed a Charnley retractor careful to avoid injury to the sciatic nerve. We released 1 cm of the gluteus maximus insertion of the femur. We then removed the proximal portion of the hip external rotators from the greater trochanter exposing the capsule. The capsule was then opened.
We then placed a bent pin superior to the acetabulum to help measure both offset and length. We dislocated the hip, resected the femoral neck, and placed retractors about the acetabulum. We then removed the labral tissue and then sequentially reamed up to a size 53. We then irrigated and impacted in the Trident PSL acetabular shell in a position of 45 degree abduction and 25 degree forward flexion. Once it was fully seated, we then drilled, measured and placed 2 cancellous bone screws to the shell.
We then put the trial liner. We focused on the femur. Then, we used the box cutting chisel, canal finder, trochanteric reamer and then we sequentially reamed the canal up to a size 15. We broached up to a size 9 and we were happy with the restoration length, range of motion and stability.
We removed all the trial components, irrigated. We impacted the Stryker 36 mm inner diameter, Trident X3 0-degree polyethylene insert into the shell, fully impacted it. We again did trial reduction, so now we were happy with the +5, 36 ball. We dried and cleaned the taper, impacted on 36 +5, C-Taper femoral head.
We then irrigated, reduced the hip. We closed the capsule with #5 Ethibond, the tensor fascia with #1 Vicryl and 2-0 in the subcutaneous tissue. We then reapproximated the skin edges with a 3M product called the Steri-Strip S wound closure product. We put dressing on, abductor pillow, and brought the patient to the recovery room in stable condition.
POSTOPERATIVE PLAN:
1. Physical therapy, hip dislocation precautions for 12 weeks and 100% weightbearing.
2. The patient will receive pain medication.
3. The patient will receive DVT prophylaxis. Her goal would be Coumadin, INR of 2.0 for a period of 3 weeks followed by an aspirin a day until week 12.
