DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Severe osteoarthritis involving the left hip with significant acetabular cysts.
POSTOPERATIVE DIAGNOSIS: Severe osteoarthritis involving the left hip with significant acetabular cysts.
OPERATION PERFORMED: Left total hip arthroplasty with autologous bone graft to the acetabulum.
SURGEON: John Doe, MD
BLOOD LOSS: 200 mL.
ANESTHESIA: Spinal and general.
INDICATION FOR OPERATION: This is a (XX)-year-old female who had been brought in with a complaint of left-sided hip pain. She had decreased range of motion of the hip, trouble putting on her shoes and socks, leg length discrepancy with her left leg short, activity-related pain, and diminished quality life. She has been previously treated for cardiovascular disease and is otherwise quite healthy. The clinical examination demonstrated a Trendelenburg-type gait, painful range of motion, particularly internal and external rotation. The patient is neurologically and vascularly intact. No significant calf pain. Radiographs demonstrated osteoarthritic changes involving the left hip, severe, with significant acetabular cysts. The plan will be a total hip arthroplasty with autologous bone grafting to the acetabulum. Risks and benefits of the surgical procedure were explained and consent was obtained.
DESCRIPTION OF OPERATION: The patient received antibiotics in the preoperative holding area and was brought into the operating room where the anesthetic was administered. She also had a Foley catheter placed. She was then rolled into the right lateral decubitus position with an axillary roll and held in position with a padded clamp. The left lower extremity was then scrubbed and draped in the usual fashion.
We did a 4 inch incision centered over the left greater trochanter and dissected down through the skin and subcutaneous tissue 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 then proceeded to remove the short external rotators at the posterior aspect of the greater trochanter exposing the capsule. The capsule was T’d in the 1 o’clock position. We then placed a pin in the acetabulum to help measure both offset and length. We dislocated the hip, we resected the femoral head, we did an anterior capsulotomy, and we replaced retractors about the acetabulum. We did sequential reaming of the acetabulum up to a size 50. We then removed soft tissues from the cystic lesions of the acetabulum. We then used previously removed cancellous bone grafts to pack the cystic lesions. We reverse reamed the acetabulum with a size 50. We then, after irrigating, impacted in the acetabular shell. We put it in a position of 45 degree abduction and 25 degree forward flexion. Once it was fully seated, we placed two cancellous bone screws and a trial liner.
We then focused our attention on the femur. We used a box cutting chisel, canal finder, and trochanteric reamer, and we sequentially reamed the femur up to a size 15. We broached up to a size 9. We then did a trial reduction and were happy with the length restoration, range of motion, and stability. We removed all of the trial components. We impacted in the Trident 10-degree polyethylene insert, 32 mm inner diameter. We then impacted in a Secur-Fit Plus Max 127 degree neck angle, hip stem size 9. We then performed again a trial reduction, and we were quite happy with the +0 head. We removed the trial, cleaned the taper, and impacted on the Alumina C-Taper head.
We then thoroughly irrigated the hip, closed the capsule with #5 Ethibond. We closed the tensor fascia with a #1 Vicryl and closed the subcutaneous tissue with 2-0 Vicryl. We used staples on the skin. We then put a nonadherent dressing, 4 x 4’s, ABD pads, and tape. The patient had an abductor pillow placed and was rolled into a supine position, put on the hospital bed, and brought to the recovery room in stable condition.
