Right total knee replacement with lateral release

PREOPERATIVE DIAGNOSIS:                Right knee osteoarthritis.

POSTOPERATIVE DIAGNOSES:           Right knee osteoarthritis, advanced arthritis, tight lateral retinaculum.

PROCEDURE PERFORMED:                  Right total knee replacement with lateral release.

BLOOD LOSS:                                             Minimal.

FLUIDS:                                                        Crystalloid.

COMPLICATIONS:                                                 None.

HARDWARE USED:                                   Zimmer 'E' GSF right LPS femur, a 10 LPS Flex _____ poly, a 4 stem tibia, and a 29 prolonged patella.

DRAINS PLACED:                                      Medium Hemovac drain placed.

ANESTHESIA:                                            Epidural, regional and spinal.

INDICATIONS FOR SURGERY:              The patient is a woman with right knee arthritis. The risks, benefits, and alternative of the treatment discussed with the patient in detail, and she wished to proceed with surgery.  She was cleared medically by her primary physician, Dr. Castellanos and the patient wished to proceed with surgery.

PROCEDURE IN DETAIL:  The patient was identified, brought to the operating room, placed in supine position on the table.  After induction of a femoral nerve block on the right lower extremity as well as a spinal, the right lower extremity was prepped and draped in the usual sterile fashion.  Foley placed.  The patient's leg was exsanguinated, tourniquet inflated to 300 mmHg.  The patient had received Ancef preoperatively.  At this point, dissection carried down to the fascia.  The fascia was then identified and the medial parapatellar approach performed.  We released the medial side.  We then released some of the lateral side.  The patella was covered with a very thick fat pad, which was excised.  ACL and PCL were released and then we drilled our tibial and femoral tunnels.  We then first _____ our standard cut in the femur.  We then externally rotate 3 degrees and cut the distal femur sizing it to an ‘E.’  We then cut the PCL box.  We then went to the tibia.  The tibia was cut perpendicular to the shaft of the tibia.  The patient was quite large, and we used both the intramedullary guide as well as extramedullary guidance by using the alignment rods.  Once we cut it, we then checked our flexion and extension gaps, which was noted to be excellent and 10 mm in extension without difficulty.  We then checked our alignment once more.  Next, we rotated the tibia externally and we punched the tibia to a size 4, which covered the tibia nicely.  We then went to the patella.  We sized to a 29.  The patella was quite tight and we trialed it and then we realized we needed to release lateral retinaculum since we had had a tight retinaculum throughout the case.  Once we did this, we then placed our final cemented components in place.  We then trialed once more.  We selected the size 10 tibia since it fit nicely, gave good stability and excellent motion.  We then irrigated with saline.  We closed with #1 Vicryl, 2-0 Vicryl, and staples for the skin.  A medium drain had been placed out laterally.  The patient was then brought to recovery room.  My assistant was essential during this case.