Best Operation Note

**Orthopaedic Surgeon** **Theatre episode:** St. Jude's Hospital **Surgeon:** Dr. Emily Thorne **Anaesthetist:** Dr. David Lee **Assistant:** Dr. Sarah Jenkins **Procedure:** Right Total Hip Arthroplasty (Posterior Approach) **Prosthesis:** Stryker Accolade II femoral stem with Trident acetabular cup and ceramic-on-ceramic bearing. Informed consent was obtained from Eleanor following a thorough discussion of the risks and benefits of the procedure, as well as the alternative conservative management options. Eleanor's recent medical history includes well-controlled hypertension and no known drug allergies. Anaesthesia was general, supplemented with a spinal block for post-operative pain control. 1g of Cephazolin was administered intravenously pre-operatively. Eleanor was positioned in the left lateral decubitus position on the operating table. A time-out procedure was performed, confirming the correct patient, procedure, and site. The right hip and surrounding area were prepped with chlorhexidine and draped in a sterile fashion. Eleanor was positioned carefully to allow for optimal surgical access. A standard posterior approach was utilised, with a curvilinear incision centred over the greater trochanter. Local infiltration with Ropivacaine and Adrenaline was performed. The gluteus maximus was split, and the short external rotators were detached and tagged for later repair. The hip joint was dislocated, and the femoral head was resected. The acetabulum was then reamed to the appropriate size, and the Trident acetabular cup was impacted into place. Multiple screws were used for additional fixation. The femoral canal was prepared, and the Accolade II femoral stem was inserted, followed by the ceramic femoral head. The joint was then reduced, and stability and range of motion were assessed, confirming excellent stability throughout the physiological range. There were no intraoperative complications. The short external rotators were repaired to their original insertion point. The deep fascia and subcutaneous layers were closed with interrupted 2-0 Vicryl sutures. The skin was closed with a running 3-0 Stratafix suture. A Cuticerin dressing was applied, followed by a sterile Allevyn dressing. **Plan** Eleanor will continue with intravenous Cephazolin for 24 hours post-operatively. Anticoagulation with rivaroxaban will be initiated this evening. Eleanor will be encouraged to mobilise with partial weight-bearing as tolerated with the aid of a physiotherapist starting tomorrow. A wound check with the GP is scheduled for Eleanor in 10 to 14 days please, and Eleanor will have a follow-up appointment with Dr. Thorne in the outpatient clinic in 6 weeks.