Total Knee Arthroplasty
I. Anatomy/Pathophysiology- How does the anatomy work and what went wrong
II. Diagnostic testing (please be detailed in the type of test, how it is performed, and relationship to the pathophysiology). A physical exam is done to determine the level of range of motion, pain, and stability to see if doing a total knee arthroplasty would help relieve symptoms. Fluid is taken from the knee joint, typically using a needle and syringe for a culture to rule determine if there is presence of an infection. X-rays (anteroposterior and lateral) are taken of the affected knee and images will be up in the operating room intraop (Frey Association of Surgical Technologists, Inc., 2017).
III. Surgical intervention (surgical preparation for the surgical technologist)
IV. Surgical intervention (procedural steps). Please include:
A. Positioning/positioning aids: Patient is supine, arms extended on padded arm boards. Webril applied to affected leg then tourniquet placed on top of webril dressing. A bed roll is placed superior to the affected leg to hold the leg at an angle, a knee wedge is attached to the bed to keep the affected knee from moving laterally. An antihemolytic stocking is applied to the unaffected leg. Safety straps securing patients arms and waist.
B. Prep solution and area prepped: Duraprep, prep the area starting at the knee cap up to just below the tourniquet on the upper thigh then work from the knee down to the ankle circumferentially. An IV pole with a leg holder strap attached to it to keep the leg elevated when prepping, while prep solution is drying, and to not contaminate.
C. Supplies: Bair Hugger, Pulsavac, cement mixing bowl, esmark, double ace wrap, Aquamantys, webril, extra mayo stand, hood (space suit), osteotomes, lateral collateral retractors, power drill, power saw, batteries (Saenz, 2018).
D. Draping: With the leg still elevated a quarter sheet is draped over the end of the table where the legs are. A tube stockinette is rolled over the foot and rolled a quarter of the way towards the knee. Then a split sheet is placed under the leg with the adhesive tails covering the inferior portion of the tourniquet. An extremity sheet is then draped over the leg, and per surgeon’s preference coban is wrapped over the stockinette (Saenz, 2018).
E. Incision: An anterior midline incision is made with the knee in flexion.
F. Equipment and what it was used for: Suction unit, electrosurgical unit, tourniquet, and an IV pole with a footstrap,
G. Suture (Type, size, needle, and usage): 2 Stratafix 3-0, 2-0 Vicryl CP-2 (2x), 4-0 Monocryl, 0 Vicryl (in the room)
H. Instruments (spend time on the instruments used for the substantive part of the procedure, not opening and closing) Trays used: Ortho tray, minor tray, femoral tray #1 and #2, tibial tray #1 and #2, UC insert trial tray, femoral trial tray (Ortho Development, 2016)
I. Procedure steps (detailed anatomy)
J. Counts (what was counted and when)
K. Specimen and how it was cared for: No specimen was collected
L. Drains and dressings: No drains were used, for dressing Dermabond Prineo skin closure system is used, ABD 8×10, double 6″ Ace wrap.
V. Special considerations (include the patient aspects, as well as case and physician specific items)
VI. Complications- Surgical site infection, hemorrhage, deep vein thrombosis (DVT), restricted range of motion, neurovascular complications due to prolonged use of the tourniquet, uneven leg length (Frey Association of Surgical Technologists, Inc., 2017).
VII. Postoperative care: Patient is transported to the PACU and will be monitored for hemorrhage and pain management. Depending on the patient a CPM (continuous passive motion) device will be applied in the PACU to reduce inflammation, provide passive motion in a specific plane of movement, and protect the healing repair or tissue. During the first 24 hours the patient will remain under direct care of medical staff, hydration and control of pain and inflammation is key to help for recovery and rehabilitation. The patient will try and begin to walk after the first 24 hours postoperatively, if not complications are present patients is discharged from the hospital in three to four days. (Frey Association of Surgical Technologists, Inc., 2017) (Goldman, 2008).