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Total Knee Arthroplasty

Thomas S. Thornhill, MD, David J. Lee, MD
Brigham and Women's Hospital

Anesthesia

  1. Following suitable premedication, the patient is taken to the operating room where general anesthesia is induced.

Positioning

  1. The patient is placed in the supine position upon a carefully padded operative frame.
  2. A tourniquet is applied to the upper leg.
  3. The upper leg is prepped and draped as a sterile field.

Exposure

  1. A midline incision is made over the knee.
  2. The capsule is opened in a medial parapatellar fashion.
  3. The patella is everted and the patellofemoral ligament is sacrificed.
  4. Continue exposure by medial release and partial meniscectomies.
  5. ACL is sacrificed.

Bone Cuts

  1. Bony cuts are made in this order: distal femur, then posterior femur, then proximal tibia.
  2. Trial components inserted.
  3. Pericapsular injections are done.
  4. Patella is then prepared.

Component Insertion

  1. Trial components are placed and full flexion and extension are assessed.
  2. Femoral and tibial surfaces are cleaned and dried, then components are cemented.
  3. Excess cement is trimmed.
  4. Ensure that there is no impingement and medial and lateral cortical size are intact and component size is appropriate.

Wound Closure

  1. The synovium is closed with 2-0 continuous Vicryl.
  2. The capsule is closed with #2 Quill in a double fashion.
  3. Re-check full extension and gravity flexion with the capsule closed.
  4. The subcutaneous tissues are closed with 2-0 and 3-0 Vicryl.
  5. The skin is closed with Monocryl and Dermabond.
  6. A sterile dressing is applied.

Postoperative Protocol

  1. The patient is awakened from general anesthesia and brought to the post-anesthesia care unit.
  2. Patient is discharged from the hospital on postoperative day #2.
  3. The patient is made weight bearing as tolerated.
  4. Postoperative follow-up visits are scheduled.
  5. Range of motion and physical therapy are scheduled.