Total Knee Arthroplasty

Anesthesia

  • Interscalene block with general anesthesia (preferred) or sedation

  • No paralysis

  • No foley catheter

  • 2 gm Cefazolin (if PCN allergy, 1 gm Vancomycin)

  • Irrigation fluid with Epinephrine (0.33 mg/L)

 

Positioning

  • Beach chair position, Spyder arm holder, padded leg cushion

  • OR bed turned 30° from anesthesia (i.e. turned "slightly")

  • Foot-control electrocautery (Ambient MegaTurbo Vac) and shaver (4.5 mm S&N Incisor Elite Premium straight)

  • One non-sterile 1015 drape 

  • Two sterile U-drapes with additional 3M Steri-Drape U-Pouch

 

Surgery

  • Equipment

    • Arthroscopy tower

    • Shoulder arthroscopy instruments with 30° and 70° scopes

    • Power drill

  • Cannulas

    • 7 mm threaded cannula x 2

  • Implants

    • Newton-Wellesley Hospital

      • Rotator cuff repair

        • Arthrex swivelock 4.75 mm anchor x 4

        • 2mm Fibertape x 2 (can be one Fibertape and one Tigertape)

        • 18G spinal needles x 2

        • Suturelasso passing instruments with looped Nightnal wire

    • Norwood Hospital

      • Rotator Cuff Repair

        • S&N 5.5mm Healicoil PK anchor (x3) w/ one Ultratape and one Ultrabraid suture (product #72203984)

        • S&N 5.5mm MultiFix S Ultra (x2) anchor (product #72290001)

        • S&N 2.8mm Q-fix all-suture anchor disposable kit (product #25-2800)

        • S&N Firstpass ST suture passer

        • S&N AccuPass 70° Upbend

 

Closure

  • 2-0 Vicryl x 1

  • 1/2" steri-strips cut in half (6 total)

  • 4x4 gauze with foam tape about the shoulder

  • Shoulder brace/sling will be brought by the surgeon

  • Discharge home

 

Resources

  • Coming soon

Position with the surgical side closer to surgeon (right shoulder above)

Norwood:  7.5 bio x 2

NWH:  7.5 bio, 8.0 bio

This card can be used as the "base" for every arthroscopic shoulder procedure.  Particular of each case are stated below.

Anesthesia - Spinal on everyone (recovery is better).  No narcotics (nausea and urinary retention).  Should wear off by time patient reaches floor.

Foley Catheter - No

Nerve Block - Adductor canal (gets anterior and medial knee)

Local - Ropivicaine with epi and toradol mixture injected into posterior capsule

Antibiotics - One dose of cefazolin pre-op and two doses post-op.  For PCN allergic patients, cefazolin unless severe allergy documented.  If significant allergy present, one dose of vancomycin pre-op and two doses post-op.

OR Setup - Antibiotic cement, Simplex (more runny) > Palicose.  Sterile leg holder with side post (from hip grip set) (leg holder for Mako?) to position at 30/90 degrees.

Specific Equipment - 2 large lamina spreaders, pulse lavage, bent hohman retrators

Technique - Leg in De Mayo leg holder, leg exsanguinated with Esmarch, tourniquet to 300 mmHg, midline incision, medial parapatellar arthrotomy, medial release, lateral patellofemoral ligament release, posterior half of infrapatellar fat pad resected, patella everted and knee flexed, osteophytes excised, femoral holde drilled in center of patellar sulcus, canal fat suctioned, flexible IM rod, cut distal femur, IM tibial guide hole drilled just lateral to ACL insertion, suction canal fat, cutting block centered on medial 1/3 of tibial tubercle, varus/valgus verified with exrtramedullary alignment rod pointing to second toe, resect 2 mm off low side or 10 mm off high side, tibia cut, meniscal remnants removed, size tibia and check alignment with drop rod, 

Pain Cocktail Injection - bupivicaine 80 mg, methylprednisolone 40 mg, morphine 4 mg, epinephrine 300 mcg, cefuroxime 750 mg diluted in 30 ccs of normal saline.

Drain - Default is no.  Medium hemovac if weepy.

Closure - 3-0 subcuticular monocryl with Dermabond (Prineo) dressing.  If no Dermabond, then 3-0 nylon with Aquacel dressing.  If very thin skin, staples.

Post-Op Dressing - ACE bandage from foot to upper thigh with Iceman machine

Knee Brace - Default is no.

DVT Prophylaxis - ASA 325 mg BID.  If history of clots or high risk, Lovenox 40 mg SQ qday beginning 12 hrs after surgery.  SCD's for every patient.

Foley - No foley unless there is a reason.  If foley in place, continue antibiotics until removed (+/- Bactrim)

Rehabilitation - Get up on first day is key!  Insentive spirometer for every patient.  

LOS Expectiation - 50% discharged on POD #1, 50% discharged on POD #2.

 

Contact Information

Ortho.Boston 

145 Rosemary Street, Suite C

Needham Heights, MA  02494

Phone:  781-429-7700

Fax:  781-429-7701

Billing:  781-881-2189

E-mail:  team@ortho.boston

Hours

Monday - Friday:   8:30am - 5:00pm

Saturday:   By Appointment

Sunday:   Closed

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