Inpatient Hip Replacement chart- OP report

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OPERATIVE REPORT

 

Pre-Op Diagnosis Codes:

   OSTEOARTHRITIS OF RIGHT HIP

 

Post-Op Diagnosis Codes:

   OSTEOARTHRITIS OF RIGHT HIP

 

Procedure(s) (LRB):

HIP REPLACEMENT ANTERIOR APPROACH TOTAL (Right)

 

 Anesthesia Type:

Spinal

 

Findings:

     Severe DJD right hip

  

Severe osteoarthritis of the hip that has failed nonsurgical management

 

Procedure details:

Patient was met in the preoperative holding area.  History and physical was performed.  Signed informed consent was obtained.  The operative extremity was marked.  The anesthesia team performed a spinal anesthetic in the preoperative area.  Patient was then taken into the operating room.  Briefing was performed confirming patient name laterality and intended procedure, all members of the team were in agreement.  A radiological timeout was performed.  Preoperative antibiotics and TXA were given.  The patient was then transferred to the Hana table and secured in a regular fashion.  Preoperative fluoroscopic imaging was performed to replicate the standing AP pelvis.  The operative extremity was then prepped and draped in the usual standard fashion.

 

A 9 cm incision was made lateral and distal to the ASIS.  Soft tissue was carefully dissected until the TFL fascia was reached.  The TFL fascia was sharply incised.  The interval between the TFL and the sartorius was bluntly developed.  The lateral femoral circumflex vessels were identified and coagulated using the electrocautery and a clamp.

 

Capsulotomy was made and the flaps were tagged for later repair.  A neck cut was made using an oscillating saw.  Gross traction and 50 degrees of external rotation were placed on the leg via the Hana table. The femoral head was removed using a power corkscrew.  The acetabulum was exposed.  The labrum and the pulvinar were removed using electrocautery.  The acetabulum was sequentially reamed starting at approximately 3 mm below the measured head size. The final cup was then impacted into position the final cup position was confirmed using fluoroscopic imaging.  2 acetabular screws were then placed for additional fixation. 

 

The polyethylene liner was placed in the acetabulum and impacted into place.

 

Attention was then turned to the femur.  Gross traction was removed the femur was then externally rotated to 90 degrees.  Additional release of the capsule near the calcar was performed.  The femur was then rotated to 120 degrees. The leg was then extended and adducted.  The capsule along the superior neck was then released.   Once adequate exposure of the femur was obtained we began with canal preparation. A box osteotome was used to remove lateral bone.  A rongeur was then used to remove any additional lateral bone.  A starter broach was manually placed into the canal to both identify the canal and to remove additional bone.  The canal was then sequentially broached. The final broach was rotationally stable and did not go further into the canal when impacted.  Trial reduction was performed.  Imaging confirmed appropriate broach size. 

 

Leg lengths were evaluated using fluoroscopy with a drop rod placed across the lesser trochanters

 

The hip was then dislocated and all implants were removed.  The final stem was impacted into place.  The final ceramic head was placed onto the trunnion after the trunnion was cleaned and the hip was re-reduced. Final fluoroscopic images confirmed appropriate placement of the femoral stem.  The wound was then filled with dilute Betadine solution and this was allowed to sit for 3 minutes.  The hip was injected with the Dalury cocktail in both the deep and subcutaneous tissues.

 

The capsule was then repaired with #1 Polysorb sutures.  The fascia was repaired with #1 polysorb sutures.  Deep fat was closed with 0 Polysorb sutures. The dermis was closed with 3-0 Polysorb sutures.  The skin was closed with subcuticular 3-0 Biosyn and skin glue.  A Aquacell dressing was placed.

 

Patient was then transferred to the gurney and taken to the PACU in stable condition.

  

Estimated Blood Loss:

   250 cc

 

Fluids:

   See anesthesia record

 

Drains:

  none

 

Complications:

   (1) No - Per Surgeon/Proceduralist  Comments: none

(2) No - Per Anesthesia Provider  Comments: none

 

Specimens:

* No specimens in log *