Neida Caroboone_editing_S-43

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Valencia College *

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1611C

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Medicine

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Dec 6, 2023

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docx

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5

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Orthopedic Surgery Report Patient Name : Lightbourne Byfield Patient ID# : S-43 Date of Operation : 10/07/-- Age/Sex : 55/Male PREOPERATIVE DIAGNOSIS : Left knee degenerative arthritis. POSTOPERATIVE DIAGNOSIS : Left knee degenerative arthritis. SURGEON : Dr. Gilbert M. Fields, MD ASSISTANT : Dr. David Castillo, MD ANESTHESIA : Epidural performed by Dr. Avalon, MD OPERATION PERFORMED : Left total knee arthroplasty. INDICATIONS : Mr. Byfield, a native of Jamaica, who has been followed in the orthopedic clinic, has had pain with his knee for quite some time, and has had x-rays exhibiting degenerative changes in his knee in the medial department. He has had significant pain, and he failed conservative treatment. He has been unable to tolerate things without activity restriction. Steroid injection and biscuit supplementation has not acute relief for him. He has had no significant findings in his knee other than the degenerative changes. For the above reasons, patient requested we go ahead with knee arthroplasty. He does have multiple medical problems, but prior to his procedure he was evaluated thoroughly by Internal Medicine. He has a Greenfield filter in place because of a history of DVT. He was on Coumadin, which he stopped prior to the procedure in adequate time to resume a normal INR. He has had MS with no flairs for 10 years. He has a history of chronic obstructive pulmonary disease. On his left side, his involved side, he has a history of an old tibial fracture that did complicate the alignment because we had to base our alignment off the proximal tibial alone. However, we were very well aware of this and prepared for this when the procedure started.
PROSTHETIC DEVICES : Implants include a Zimmer NexGen knee. The tibial component was a size 6 stemmed component. The femoral component was a size F. The poly was a 12 mm. The patellar reamer was a 41 mm reamer. The Ollier implant was 35 mm diameter, 9 mm thickness. PROCEDURE IN DETAIL : Patient was brought to the operating room after his Ancef had been instilled. He was prepped and draped in the usual sterile fashion. Our standard medial parapatellar incision was used. We dissected it Orthopedic Surgery Report Patient Name: Lightbourne Byfield Patient ID#: S-43 Date of Operation: 10/07/-- Page 2 and excised our tissues to visualize our joint well. After we had excellent visualization of our joint, we made our tibial cut first. The tibial cut was resected based off the deficient side. A 2 mm resection was based off the medial side, and the alignment was based off the anterior tibial press approximately. We did not want to align him based on his foot because he has a distal angulation, which he has tolerated well for many years. If we turned him back, this would cause him further problems. We then verified that our cut was well aligned using the long aligning guide. We then turned our attention to his femur. The femoral sizer was placed into the hole. We visualized that this was a size F femur. Based on that size, we then placed the distal femoral cutter on. A standard distal cut was made, and this was at 6 degrees of valgus. The pets were then measured using 10 mm and 12 mm blocks, and we found that we had a square space, and the soft tissues were well aligned and required no releases. Based on these 2 cuts, we then placed our size F 4-in-l cutter. Using this cutter with 1 pin into the anterior tibia, we positioned it using the tensioner. The tensioner device was turned off the posterior condyles to 40 mm on each side. This approximated a square box. We turned our anterior 4-in-l cutter to align and make a perfectly square in 90 degrees of flexion and pinned this in place. This was approximately 3 degrees of external rotation and seemed very appropriate. We then made our 4 cuts and notched for our groove as well as making our mock holes on the femur. The femoral notch cutter for the posterior stabilizing device was then placed. This box was cut cautiously, and there were no notches made. We then finished our tibia using the size 6 tray. The size 6 tray fit well, and it
was aligned off the tibial tubercle to be central. It was placed in a slight amount of external rotation. Then we placed our trial implants and turned our attention to the patella. The patella took us some time because after we reamed down to 14 mm of remaining thickness, we placed the buttons, and a 35 mm button was used. However, it was into very hard, corticated bone in one location. This drill hole took us quite some time to get into perfect position. Eventually, by putting the drill into a drill instead of into a reamer, Orthopedic Surgery Report Patient Name: Lightbourne Byfield Patient ID#: S-43 Date of Operation: 10/07/-- Page 3 we were able to drill this hole sufficiently. We found the patellar implant set perfectly. This took approximately 10 or 15 minutes, slowing us down. We then mixed cement, washed the joint thoroughly with sterile saline, removed all loose soft tissues, and prepared the implants on the back table. Cement was applied to both the implants and to the tibia. The tibia was tamped into place. All excess cement was removed. We then implanted the femoral implant. Cement was placed into the plug holes and excellent alignment was achieved. This was tamped down into place and was visualized to be down in all locations. Excess cement was removed. We then put our patella in place using a patellar clamp, clamping it down and holding it in position during the cement hardening process. This all was achieved easily, and we placed the 12 mm trial spacer in place until the cement had hardened. After it had hardened on the back table, we removed the spacer. During this time we were irrigating the knee with sterile saline. Spacer was removed, and a 12 mm poly was inserted. Once again our stability was excellent, and our range of motion was outstanding—from 0 to 125 degrees. The wound was further irrigated and closed over a drain using 2-0 Vicryl and a subcuticular 4-0 Vicryl running. Steri-Strips were placed. The patient was placed into a postop dressing and taken to recovery in good condition. He was awake during the entire procedure with epidural anesthesia. There were no complications.
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