Total Knee Revision Transcribed Medical Transcription Sample Report
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Painful left total knee with synovial entrapment.
POSTOPERATIVE DIAGNOSIS: Painful left total knee with synovial entrapment.
OPERATION PERFORMED: Left total knee revision.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
COMPONENTS UTILIZED: Smith and Nephew Legion Oxinium constrained femoral component, size 3 left, straight 12 x 160 mm Legion cemented stem, Legion distal screw on femoral wedge size 10 mm, size 3 x 2; a Legion revision tibial base plate, size 1, left, with a straight 10 x 160 mm Legion cemented stem; and a size 1 to 13 mm thickness Legion PS XLPE high flexion articular insert.
STABILITY: The patient did undergo a trivector approach. She could be fully extended and flexed to approximately 130 degrees. There was no instability to varus or valgus stressing. The patella tracked well with no-hands technique.
ESTIMATED BLOOD LOSS: 100.
TOTAL FLUIDS: 2000 crystalloid.
TOURNIQUET TIME: 85 minutes at 300 mmHg.
ANESTHESIA: Laryngeal mask anesthesia, general, with femoral catheter.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female who is status post left total knee utilizing DuPuy Sigma. She had developed synovial entrapment with pain and had arthroscopy x2 but continued to have pain. It was felt she would benefit from knee revision with lowering the joint line and changing the components. The risks and benefits of the knee revision have been explained to her in simple terms she could and did understand and she wished to proceed with the knee revision. Also, of note, we did not revise the patella.
DESCRIPTION OF OPERATION AND FINDINGS: The patient was taken to the holding room where a permit was signed. All questions were answered. The left knee was initialed. She underwent a femoral block by the anesthesia service with catheter. She was taken to the operating room where she underwent laryngeal mask airway general anesthesia. A Foley catheter was placed sterilely in the bladder. She was given preoperative IV antibiotics. A tourniquet was applied to the left upper thigh. The left lower extremity was prepped and draped in sterile fashion using DuraPrep. An impervious stockinette was placed from the tip of the toes to the tourniquet and wrapped out distally with Coban. The anterior surface was cut out and the skin covered with an Ioban drape. A time-out was performed, and all appropriate instruments were noted to be present. The leg was exsanguinated with an Esmarch and tourniquet raised to 300 mmHg.
A midline incision was once again utilized and dissection carried down to identify the extensor mechanism. A trivector approach was utilized. Upon entering the joint, cultures were obtained and sent for Gram stain, culture and sensitivity. A complete synovectomy was then performed and sent for frozen section, which was negative for acute inflammation. The patella thickness was noted to be 20 mm and she had both small femur and small tibia as well as small patella, and as we had told her prior, we did not revise the patella as it was appropriate with no wear.
Attention was then directed to the polyethylene, which was removed. We then took off the femur using the Moreland chisels with minimal bone loss. The component was not loose. Attention was then directed to the tibia, which was also removed with Moreland chisel and then using the V cutters to get the cement out of the canal. Once the cement was all removed, the canals were then reamed sequentially, 1 mm over-reamed for each the femur and tibia, for the tibia to 11, the femur to a 13. We then used an intramedullary rod in the femur based on the reamer and made a tibia cut, which was neutral to the mechanical axis. This took off minimal bone but it did make it perpendicular to the stem. This was sized to a size 1 tibia, size 2 created too much overhang.
Attention was then directed to the femur, which we then built a size 4 as well as a size 3, the 4 was actually too large medial, lateral, size 3 was appropriate and this did give us a balanced flexion-extension gap. We did bring the femur down more distally to try to lower the joint line. This was accomplished with 2 distal augments; the rotation was appropriate because did have a balanced flexion gap equal to the extension gap that were rectangular. With the trials in place, then trialed this with a 13 Poly, we started with a 9 and then 11, both went into recurvatum and 13 did not, and she had good stability. The patella itself tracked well with minimal baja noted. The patella was in appropriate position throughout.
All trial components were then removed. The canals were irrigated copiously with Pulsavac lavage and bacitracin. Cement restrictors were placed, both femur and tibia, one cement mix was created with three packs for 120. We had irrigated the wound copiously with Pulsavac lavage and bacitracin. The components were assembled on the back table and appropriately torqued. The tibia was then submitted in appropriate position followed by cementing of the femoral component; both components had cement applied to them as well as cement applied to the bone prior to cementing. The trial 13 Poly was inserted and the knee was brought to full extension. Excess cement was removed prior.
Once the cement had cured, the Poly was removed as well as excess cement. The tourniquet was released and hemostasis was obtained with electrocautery. The final Poly was snapped in place and the knee reduced, again similar motion noted as trialed, no mid flexion instability or instability noted throughout. Range of motion 0 to 130. The wound was irrigated copiously with Pulsavac lavage and bacitracin. Final poly inserted and the knee reduced. Again, similar motion noted as trialed. A medium Hemovac drain was placed superior and laterally. The deep fascia along the patella was then closed with #2 Vicryl suture in interrupted figure-of-eight fashion proximally and distally, a running #2 Quill stitch was utilized and oversewn. The subcutaneous was closed with 2-0 Vicryl suture in interrupted fashion. The skin was approximated with staples. A sterile dressing including ChloraPrep, Acticoat, 4 x 4’s, ABDs, and TED hose were then applied. The patient was then awakened, extubated, and transferred to recovery in stable condition. No complications. All counts correct.
