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Total Knee Replacement With Valgus Correction Operative Sample

DESCRIPTION OF OPERATION: The patient was placed on the operative table in the supine position.  After establishment of adequate general anesthesia, the knee was examined and noted to have stable ligamentous exam.  There was some very minimal stretch of the tibial collateral ligament.  Valgus deformity was mild.  Prophylactic antibiotics were given intravenously.  Foley catheter was placed.  The right knee area was shaved and sterilely prepped and draped in usual fashion from the toes to high above the knee.  Check was made to make sure that she had been given prophylactic antibiotics.  After completion of sterile prep and drape under UV lights, the patient was brought into enclosed environment laminar flow suite with all personnel utilizing body exhaust suits and additional sterile draping was carried out.  The site of the skin incision was isolated with Betadine-impregnated Vi-Drape. The extremity was exsanguinated.  The tourniquet was inflated to 325 mmHg.  An incision was made.  There was bleeding from the skin, thus the tourniquet was also elevated 350 mmHg and subsequently decreased after 10 to 15 minutes to 325 mmHg.  Incision was carried down sharply to the abundant adipose tissue to the level of the retinaculum.  A median parapatellar arthrotomy was made and the patella was everted without difficulty.  No release was undertaken medially due to the valgus deformity.  Meniscotibial attachments were released laterally.  The knee was flexed.  The Z-retractor was placed to protect the collateral ligaments and a centering drill hole was made in the distal femur.  Marrow contents were irrigated and suctioned until return was clear.  A fluted guide rod was placed, set at 5 degree mechanical axis, and 8 mm distal resection made and checked for accuracy. The femur was sized for a #7 component and rotation based on epicondylar axis, anterior and posterior cuts and chamfer cuts made and checked for accuracy, and groove was created for the patellofemoral groove.  Tibia subluxed anteriorly and posterior cruciate ligament partially recessed.  The tibia was exposed circumferentially.  Centering drill made and marrow contents irrigated and suctioned until return was clear.  A fluted guide rod was placed and set at 90 degree mediolateral axis and 2 degrees posterior slope and proximal tibia resection made and checked for accuracy.  The tibia sized to #7 component. Posterior recess was cleared of loose bodies and meniscal remnants and then trial components were placed.  Patella was resected along the synovial reflection, sized, and lug holes created for #7 component.  The patella tracked well with no lift-off.  The patient had equal mediolateral balance throughout the range of motion.  The knee could easily be brought to full extension and easily flexed until thigh and calf came in to full flexion at approximately 110 to 115 degrees of flexion. Rotational line on the tibia was marked.  Delta wing keel was created and cement restrictor was placed.  All cut surfaces of the bone were thoroughly pulsatilely lavaged and dried.  Cement was vacuum-mixed, placed within the keel and lug holes and pressurized into all cut surfaces of bone.  Each component was fully seated, impacted and the knee held in full extension during cement curing. Upon completion of cement curing, all prosthetic borders were carefully cleared of any excess cement.  The pericapsular tissues were injected with 30 mL of 0.5% Marcaine with epinephrine with 4 mg Duramorph.  Tourniquet was released, after giving patient heparin 2000 units intravenously. Only minimal bleeding was encountered, and it was easily controlled via direct pressure and electrocautery.  The knee was thoroughly irrigated.  The median parapatellar arthrotomy was reapproximated with interrupted #1 Ethibond suture in a figure-of-eight fashion.  The superficial layer was closed with 0 and 2-0 Vicryl sutures, and the skin was reapproximated with skin staples.  A sterile compressive dressing was placed. All sponge and needle counts for this procedure were correct.  There were no complications.  The patient was transported to the recovery room awake and in stable condition.

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