kellit21
Guru
Can anyone please help me with this surgery??
Operation:
1. Open excision of extensive scarring with release of impending trochanteric piriformis removal.
2. Removal of large impinging bone spurs trochanter posteriorly
3. Exploration of total hip components with examination visually as well as fluoroscopically for instability of the components or any loosening.
4. Reconstruction of soft tissue left total hip
In detail:
Fluoroscopy was brought in while patient was in supine position and we carefully examined the hip under fluoro and it appeared in really excellent position. No significant shock or traction instability was noted. Full range of motion without dislocation was noted by C-arm. C-arm was then discontinued. The patient was turned into a right lateral decubitus position and secured on the table. Pads were placed under the legs as well as axillary roll. We carefully dissected down to the fascia lata. We identified distally as well as the musculature proximally. There was large void consistent with subluxation of this fascia lata. It was opened along this weakness and we identified he previous tissue by following the muscle as well as the distal aspect of the fascia lata. We ten continued our dissection down to a very scarred and impinged piriformis. This was released noting a large bone spur posteriorly. This was removed with a rongeurs to the gluteus tendon on its attachment to the trochanter. This freed up the components very well. Copious irrigation was used to cleanse the wound. It was not felt that we needed any type of revision surgery to this hip. It did appear to need reconstruction. Therefore, after copious lavage, injection of diluted Exparel and multiple sticks. The piriformis was reattached to its new location along the trochanter through drill holes in the trochanter. The fascia lata was then reconstructed in pants over vest fashion as well as running a suture over this pants over vest reconstruction. This gave excellent stability to the hip and tissue.
Operation:
1. Open excision of extensive scarring with release of impending trochanteric piriformis removal.
2. Removal of large impinging bone spurs trochanter posteriorly
3. Exploration of total hip components with examination visually as well as fluoroscopically for instability of the components or any loosening.
4. Reconstruction of soft tissue left total hip
In detail:
Fluoroscopy was brought in while patient was in supine position and we carefully examined the hip under fluoro and it appeared in really excellent position. No significant shock or traction instability was noted. Full range of motion without dislocation was noted by C-arm. C-arm was then discontinued. The patient was turned into a right lateral decubitus position and secured on the table. Pads were placed under the legs as well as axillary roll. We carefully dissected down to the fascia lata. We identified distally as well as the musculature proximally. There was large void consistent with subluxation of this fascia lata. It was opened along this weakness and we identified he previous tissue by following the muscle as well as the distal aspect of the fascia lata. We ten continued our dissection down to a very scarred and impinged piriformis. This was released noting a large bone spur posteriorly. This was removed with a rongeurs to the gluteus tendon on its attachment to the trochanter. This freed up the components very well. Copious irrigation was used to cleanse the wound. It was not felt that we needed any type of revision surgery to this hip. It did appear to need reconstruction. Therefore, after copious lavage, injection of diluted Exparel and multiple sticks. The piriformis was reattached to its new location along the trochanter through drill holes in the trochanter. The fascia lata was then reconstructed in pants over vest fashion as well as running a suture over this pants over vest reconstruction. This gave excellent stability to the hip and tissue.