Diagnosis: Advanced Osteoarthritis
Operation: Left knee replacement using Zimmerman ultracongruent component, loaded antibiotic cement
Description of Procedures: The patient was brought to the operating room after satisfactory induction of Spinal anesthesia. A standard anterior incision was made followed by a median parapatellar approach to the knee. The soft tissues were released from around the medial aspect of the tibia and both the anterior and posterior cruciate ligaments were respected from the notch. An intramedullary alignment guide was used to direct the distal femoral cut at 6 degrees of valgus, was taken off due to the disparity between the medial and lateral femoral condyles in this projection. Distal femoral cut was made. Retractors were positioned around the proximal tibial cut. The minimal 2mm was taken off of the very most worn posterolateral portion of the lateral tibial plateau. The extension gap was checked. It appeared the knee would take a 10mm polyethylene.
Attention was returned to the distal femur. It sized to a size 5. Rotation was adjusted using the posterior referencing guide at 3 degrees of external rotation, it was cross-referenced with Whitesides line, which it matched and the epicondylar axis. The size 5 cutting block was attached and the distal cut on the femur were made. The proximal tibia sized to a size E. Rotation was adjusted , so the middle portion was along the medial 1/3 of the patellar tendon. The proximal tibia was then reamed and broached to accept a size E tibial component. The patella tracked well. A lateral release was not needed. The patella was not resurfaced, but the peripheral osteophytes from around the edges were removed. The trial components were removed. The bony surfaces were prepared with the pulsating lavage. One batch of high viscosity cement with antibiotic was mixed at the appropriate consistency. The tibia was cemented, followed by the femoral component. Extraneous cement was removed from around the edges and the trial 10 mm polyethylene was put onto the tibial tray. The leg was brought into full extension to allow the cement to harden. While the cement was hardening, the bone surfaces were not covered by implant, were covered by bone wax. The cement required just over 13 minutes to harden, after which the tourniquet was released. Tourniquet time was under 50 minutes. No unusual bleeding was encountered. The posterior aspect of the knee was carefully inspected to make certain there were no remnants of debris, bone cement, etc. The final deep irrigation and inspection was carried out and then the real 10 mm ultracongruent polyethylene was put onto the tibial tray. The deep tissues were closed with interrupted figure-of-eight #1 Vicryl. The subcutaneous tissues were closed with 2-0 Vicryl & skin was closed with skin staples. Bulky dressing was applied.