HBT

Tuesday, 7 August 2012

Right hip bipolar hemiarthroplasty with Stryker Accolade press-fit


PREOPERATIVE DIAGNOSIS:  Subcapital femoral neck fracture, right hip.

POSTOPERATIVE DIAGNOSIS:  Subcapital femoral neck fracture, right hip.

PROCEDURE:  Right hip bipolar hemiarthroplasty with Stryker Accolade press-fit #4, 132 degree Accolade TMZF stem, and 26 V40 head 45 mm UHR Centrax.


ANESTHESIA:  Spinal.

ESTIMATED BLOOD LOSS:  150 mL.

COMPLICATIONS:  None.

DRAINS:  None.

SPECIMEN:  Femoral head.

PROCEDURE IN DETAIL:  Following induction of anesthesia, the patient was placed in lateral decubitus position and prepped and draped in sterile fashion, right side up.  Prophylactic antibiotics of Ancef 1g had been given.  Longitudinal posterior approach was utilized through the skin and subcutaneous tissue.  The fascia was divided, and short external rotators and capsule were divided in the T-fashion.  The femoral head was removed from the acetabulum with the corkscrew.  The head was sized to a 46-mm Centrax and trial reductions of 45 and 46 mm Centrax were performed.  The femoral neck cutting guides were then utilized to cut the femoral neck in appropriate length followed by reaming and broaching to a # 4 stem.  Trial reduction was performed.  Hip was taken through a full range of motion with +0 neck length and noted to be stable.  Components were removed.  The wound was irrigated with pulsatile lavage.  The actual stem was then implanted, and the hip was taken through a full range of motion with the 46-mm trial head and noted to be stable with +0 neck length.  The actual head was implanted.  The hip was again reduced, taken through a full range of motion, and it was determined that the 46-mm Centrax was slightly tight and this was removed and trial again performed with #5, which fit well within the acetabulum and was stable and the 45 mm UHR was then selected, implanted, and hip taken through full range of motion with the actual component noted to be stable throughout full range of motion with good leg lengths.  The wound was irrigated copiously with antibiotic irrigation.  Thrombin spray was utilized.  The short external rotators and capsule repaired with #1 Ethibond interrupted vertical mattress sutures.  The fascia was repaired with #1 Vicryl interrupted vertical mattress sutures.  The wound again was irrigated and subcutaneous closed with 2-0 Vicryl interrupted vertical mattress sutures.  The skin was closed with staples.  Adaptic, 4x4s, ABD, and Micropore tape applied.  The patient was sent to the recovery room in a good condition.

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