VIOLYNPLA2
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PATIENT HAS CHRONIC SEPTIC ARTHRITIS
PROSTHESIS:
DEPUY PROSTALAC 42 BY 32 MM ALL POLY LINER
DEPUY SIZE 2 PROSTALAC MOLD STEM
32 MM COBALT CHROME HEAD WITH +5 MM NECK SEGMENT
MODIFIED
THE ANTERIOR ASPECT OF THE MEDIUS, MINIMUS AND CAPSULE WERE ELEVATED OFF THE ANTERIOR MEDIAL FEMORAL NECK, OPENING THE HIP JOINT. UPON ENTERING THE HIP JOINT THERE WAS SOME FAIRLY BENIGN APPEARING FLUID A LOT OF INFLAMATTION AND UNHAPPY TISSUE. CULTURES WERE TAKEN FROM THE HIP JOINT ITSELF. WE THEN PROCEEDED FURTHER EXPOSER. ONCE WE COULD DISLOCATED THE HIP WE DISLOCATED THE FEMORAL HEAD WHICH HAD A FAIR AMOUNT OF DAMAGE AND COLLAPS PRESENT. CUTTING ACROSS, THE LESSER TROCHANTER WAS IDENTIFIED AND THAT CUT WAS MAD IN KEEPING WITH OUR PREOPERATIVE PLAN.
INSPECTING THE FEMORAL HEAD. THERE WAS SOME FATTY DETERIORATION OF THE CANCELLOUS STRUCTURE OF THE FEMORAL NECK ITSELF. A SECTION OF TISSUE WAS SENT TO THE LAB AS WELL AS CULTURES TAKEN FROM THE FEMORAL HEAD ITSELF. GIVEN THE AMOUNT OF INFLAMATTION WE PROCEEDED WITH THE STAGED PROCEDURE. WITH THE HEAD OUT OF THE WAY OUR ATTENTION WAS TURNED TO THE ACETABULUM. A LOT OF THE CAPSULE AND FIBROTIC INFLAMMED TISSUE WAS REMOVED FROM AROUND THA ACETABLUM. WE DID A LIGHT REAMING JUST TO REMOVE THE CARTILAGE AND GET A BONY SURFACE WHICH ULTIMATELY WAS A 50 MM REAMER. WE THEN ASSESED OUR ACETABULAR ALL POLYETHYLENE COMPONENT AND OUR OVERALL POSITION BASED ON LANDMARKS. ONCE WE WERE HAPPY WITH THIS WE CEMENTED THIS IN PLACE. TWO BAGS OF CEMENT WERE MIXED ON THE BACK TABLE WITH 3 GRAMS OF TOBRAMYCIN AND 1 GRAM OF ANCEF.......THE CEMENT WAS ALLOWED TO HARDEN IN THE ACETABULUM. WE TURNED OUR ATTENTION TO THE FEMUR THE CANAL WAS OPENED AND WE BROACHED WITH A 1 AND A 2 PROXIMAL BROACH. WE USED A 2 BROACH FOR POSITIONING AND TRAILING TO BE SURE WE HAD NOT OVER LENGTHENED AS WELL AS TO GET THE ANTEVERSION CORRECT. THIS WAS MARKED ON THE FEMUR AND AGAIN A MOLD WAS MADE ON THE BACK TABLE USING THE 2 PROSTALAC WITH THE SAME COMBINATION OF CEMENT ANTIBIOTICS. ONCE THIS WAS FORMED AND WUITE HARDENED IT WAS ABLE TO BE IMPACTED IN THE FEMUR....AFTER MULTIPLE TRIAL REDUCTIONS WE SETTLED ON A +5 MM BALL SEGMENT WHICH GAVE THE BEST COMBINATION OF STABILITY AND SOFT TISSUE TENSION............
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PROSTHESIS:
DEPUY PROSTALAC 42 BY 32 MM ALL POLY LINER
DEPUY SIZE 2 PROSTALAC MOLD STEM
32 MM COBALT CHROME HEAD WITH +5 MM NECK SEGMENT
MODIFIED
THE ANTERIOR ASPECT OF THE MEDIUS, MINIMUS AND CAPSULE WERE ELEVATED OFF THE ANTERIOR MEDIAL FEMORAL NECK, OPENING THE HIP JOINT. UPON ENTERING THE HIP JOINT THERE WAS SOME FAIRLY BENIGN APPEARING FLUID A LOT OF INFLAMATTION AND UNHAPPY TISSUE. CULTURES WERE TAKEN FROM THE HIP JOINT ITSELF. WE THEN PROCEEDED FURTHER EXPOSER. ONCE WE COULD DISLOCATED THE HIP WE DISLOCATED THE FEMORAL HEAD WHICH HAD A FAIR AMOUNT OF DAMAGE AND COLLAPS PRESENT. CUTTING ACROSS, THE LESSER TROCHANTER WAS IDENTIFIED AND THAT CUT WAS MAD IN KEEPING WITH OUR PREOPERATIVE PLAN.
INSPECTING THE FEMORAL HEAD. THERE WAS SOME FATTY DETERIORATION OF THE CANCELLOUS STRUCTURE OF THE FEMORAL NECK ITSELF. A SECTION OF TISSUE WAS SENT TO THE LAB AS WELL AS CULTURES TAKEN FROM THE FEMORAL HEAD ITSELF. GIVEN THE AMOUNT OF INFLAMATTION WE PROCEEDED WITH THE STAGED PROCEDURE. WITH THE HEAD OUT OF THE WAY OUR ATTENTION WAS TURNED TO THE ACETABULUM. A LOT OF THE CAPSULE AND FIBROTIC INFLAMMED TISSUE WAS REMOVED FROM AROUND THA ACETABLUM. WE DID A LIGHT REAMING JUST TO REMOVE THE CARTILAGE AND GET A BONY SURFACE WHICH ULTIMATELY WAS A 50 MM REAMER. WE THEN ASSESED OUR ACETABULAR ALL POLYETHYLENE COMPONENT AND OUR OVERALL POSITION BASED ON LANDMARKS. ONCE WE WERE HAPPY WITH THIS WE CEMENTED THIS IN PLACE. TWO BAGS OF CEMENT WERE MIXED ON THE BACK TABLE WITH 3 GRAMS OF TOBRAMYCIN AND 1 GRAM OF ANCEF.......THE CEMENT WAS ALLOWED TO HARDEN IN THE ACETABULUM. WE TURNED OUR ATTENTION TO THE FEMUR THE CANAL WAS OPENED AND WE BROACHED WITH A 1 AND A 2 PROXIMAL BROACH. WE USED A 2 BROACH FOR POSITIONING AND TRAILING TO BE SURE WE HAD NOT OVER LENGTHENED AS WELL AS TO GET THE ANTEVERSION CORRECT. THIS WAS MARKED ON THE FEMUR AND AGAIN A MOLD WAS MADE ON THE BACK TABLE USING THE 2 PROSTALAC WITH THE SAME COMBINATION OF CEMENT ANTIBIOTICS. ONCE THIS WAS FORMED AND WUITE HARDENED IT WAS ABLE TO BE IMPACTED IN THE FEMUR....AFTER MULTIPLE TRIAL REDUCTIONS WE SETTLED ON A +5 MM BALL SEGMENT WHICH GAVE THE BEST COMBINATION OF STABILITY AND SOFT TISSUE TENSION............
Please give me your feedback
thanks