SLELISON
Guest
It looks like this question has been asked several times without response. I am hoping someone will be able to guide me in the right direction for arthroscopic removal of gouty tophi of the knee. I was thinking debridement, 29877, but am just not sure that would be correct. Thanks for your time.
POSTOPERATIVE DIAGNOSIS: Inflammatory effusion with gouty tophi in the intracondylar notch.
PROCEDURE PERFORMED: Left knee arthroscopy with removal of gouty tophi in the intracondylar notch region.
DESCRIPTION OF THE PROCEDURE: Arthroscopic photos were taken documenting the procedure. After anesthesia, the patient?s lower extremities were placed in well-padded holders.
Following this, the lower extremity was prepped and draped in the usual sterile fashion. 20 ml of 0.25% Marcaine with epinephrine were injected about the proposed portal sites. The standard anterolateral and medial portals were made, the medial with needle guidance. Blunt obturators were used to introduce the scope cannula and care was taken throughout the case to avoid injury to the articular surfaces.
The knee was explored in a systematic fashion. Immediately upon entering the knee joint, an inflammatory effusion exited. This was immediately cultured and fluid collected for analysis of possible crystals, cell count, and Gram stain. Upon entering the knee joint, the medial compartment showed no meniscal tears and no visible chondromalacia of the medial compartment. The intracondylar notch revealed two separate nodules, which were consistent with gouty tophi. These were removed with arthroscopic suction shaver device. The reconstructed ACL was in excellent condition. There was no evidence of an acute tear there. The lateral compartment was entered and there was no unstable lateral meniscus tear. There was mild chondromalacia, grade 2, of the lateral femoral condyle about 50% and of the tibial plateau. Throughout the knee, there were small bits of white material consistent with gouty depositions. The scope instruments were removed and then the blunt obturator was used to introduce the scope cannula into the anteromedial portal into the patellofemoral joint. The patellofemoral joint was examined and had no significant chondromalacia. There was some inflammation in the suprapatellar pouch region consistent with the knee inflammation. There were no loose bodies in either side of the suprapatellar pouch region. The whitish
deposits were removed with the suction shaver device. At this point, the arthroscopic cannula was gently introduced into the posterior aspect of the knee just medial to the PCL. There were no loose bodies in the posterior aspect of the knee joint. The knee was copiously irrigated and suctioned. 1/8th inch drain was placed and brought through the suprapatellar pouch exiting the medial aspect superiorly well away from the saphenous vein and nerve. It was sewn into position with 3-0 silk suture. The patient had been given Ancef preoperatively. However, it appeared to me that the Ancef had probably not reached the effusion of the knee to a significant extent to the time of culture procurement. A Bacitracin gauze dressing was placed and the patient appeared to have tolerated the procedure well.
POSTOPERATIVE DIAGNOSIS: Inflammatory effusion with gouty tophi in the intracondylar notch.
PROCEDURE PERFORMED: Left knee arthroscopy with removal of gouty tophi in the intracondylar notch region.
DESCRIPTION OF THE PROCEDURE: Arthroscopic photos were taken documenting the procedure. After anesthesia, the patient?s lower extremities were placed in well-padded holders.
Following this, the lower extremity was prepped and draped in the usual sterile fashion. 20 ml of 0.25% Marcaine with epinephrine were injected about the proposed portal sites. The standard anterolateral and medial portals were made, the medial with needle guidance. Blunt obturators were used to introduce the scope cannula and care was taken throughout the case to avoid injury to the articular surfaces.
The knee was explored in a systematic fashion. Immediately upon entering the knee joint, an inflammatory effusion exited. This was immediately cultured and fluid collected for analysis of possible crystals, cell count, and Gram stain. Upon entering the knee joint, the medial compartment showed no meniscal tears and no visible chondromalacia of the medial compartment. The intracondylar notch revealed two separate nodules, which were consistent with gouty tophi. These were removed with arthroscopic suction shaver device. The reconstructed ACL was in excellent condition. There was no evidence of an acute tear there. The lateral compartment was entered and there was no unstable lateral meniscus tear. There was mild chondromalacia, grade 2, of the lateral femoral condyle about 50% and of the tibial plateau. Throughout the knee, there were small bits of white material consistent with gouty depositions. The scope instruments were removed and then the blunt obturator was used to introduce the scope cannula into the anteromedial portal into the patellofemoral joint. The patellofemoral joint was examined and had no significant chondromalacia. There was some inflammation in the suprapatellar pouch region consistent with the knee inflammation. There were no loose bodies in either side of the suprapatellar pouch region. The whitish
deposits were removed with the suction shaver device. At this point, the arthroscopic cannula was gently introduced into the posterior aspect of the knee just medial to the PCL. There were no loose bodies in the posterior aspect of the knee joint. The knee was copiously irrigated and suctioned. 1/8th inch drain was placed and brought through the suprapatellar pouch exiting the medial aspect superiorly well away from the saphenous vein and nerve. It was sewn into position with 3-0 silk suture. The patient had been given Ancef preoperatively. However, it appeared to me that the Ancef had probably not reached the effusion of the knee to a significant extent to the time of culture procurement. A Bacitracin gauze dressing was placed and the patient appeared to have tolerated the procedure well.