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Ashley Swafford / Case 9 Report 3

Markus LeRoy Johnson, PA-C

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Jaslynn White
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1K views

Ashley Swafford / Case 9 Report 3

Markus LeRoy Johnson, PA-C

Uploaded by

Jaslynn White
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Ashley Swafford / Case 9 Report 3

OPERATIVE REPORT

Patient Name: Marilyn Sue Stone

Patient ID: 116588 DOB: 01/24/---- Age: 50 Sex: F

Date of Admission: 02/07/----

Date of Procedure: 02/08/----

Admitting Physician: Jesse D. Smith, MD, Orthopedics

Surgeon: Jessie D. Smith, MD, Orthopedics

Assistant: Markus LeRoy Johnson, PA-C

Anesthesia: General endotracheal given by Dr. Carl Erickson Avalon.

Preoperative Diagnosis: Failed right total hip replacement with lysis and
femoral loosening, probably acetabular loosening.

Postoperative Diagnosis: Same

OPERATIVE PROCEDURES:

1. Revision of total hip replacement, right hip


2. Allograft bone graft, right hip.

Specimen Removed: Prosthesis

IV Fluids: See anesthesia records

Estimated Blood Loss: 300ml

Urine output: Not recorded.

Complications: None.
PROCEDURE IN DETAIL: The patient was brought to the operating room, and
after satisfactory anesthesia, was placed in the left lateral decubitus position.
The right hip was prepped and draped. A previously made incision was
reopened over the greater trochanter and carried down to the IT band. The IT
band was opened in the direction of the skin incision. The anterior 1/3 of the
gluteus medius/minimus group was reflected off the trochanter over to the
anterior brim of the pelvis. The hip was dislocated. The femoral component
was easily removed. It was loose in the cement. The polyethylene cup was
loose and easily removed. There was a lot of cement in and around
acetabulum. We debrided most all of this. There was a wire mesh plug
medially that went into the pelvis. It was left in place. There was also one in
ischium that was quite stable and it was left in place. There was a large defect
in the medial wall of the acetabulum about the size of a silver dollar. It did not
appear to be a pelvic dissociation. Due to the shape of the acetabulum and
bone loss it was necessary to use an acetabular cage.

A Burch-Schneider retention cage was then fitted to the acetabular rim which
was circumferentially intact. It fit very well. Allograft bone graft was
morselized. A piece of femoral head allograft was placed on the acetabular
defect and then allograft cancellous bone chips were packed into the defect.
We then inserted the Contour retention cage. It was fixed to the wing of the
ilium using 4 screws. We also put a screw inferiorly. This construct was quite
stable. Methyl methacrylate cement was used to cement a 46mm All-Poly cup
into the cage. Excellent fixation was obtained.

Attention was then turned to the femur. A trochanteric osteotomy was


performed to mobilize the shaft of the femur. All cement was removed from
the femoral canal. The femoral canal was deemed to accept a 12mm stem.
The stem was 12mm x 190mm with a 15mm buildup. We hammered this
down into position. It was very stable. A +8 x 28mm head was applied. The
hip was relocated. This restored leg length measurements taken from the
anterior brim of the pelvis. The osteotomized trochanter was reattached to
the shaft of the femur. The anterior 1/3 of the gluteus medius/minimus group
was repaired back to the trochanter using #1 Vicryl. The IT band was closed
with #1 Vicryl reinforced with a RR#1 PDS suture.

Subcutaneous tissues were closed with O Vicryl and the skin was closed with
running subcuticular prolene. A compression dressing was applied and the
patient as taken to a PACU in good condition. Estimated blood loss was
300ml. None replaced.

_______________

Jesse D. Smith, MD, Orthopedics

JDS: xx

D: 02/08/----

T: 02/08/----

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