Spinal Anesthesia for Ambulatory Hip and Knee Arthroplasty Procedures
Bruna Castro de Oliveira, MD
Massachusetts General Hospital
This educational video article details the technique of spinal anesthesia administration for total hip and knee arthroplasty. The presentation details key procedural elements, including anatomical landmarks, midline and paramedian techniques for spinal placement, equipment for spinal anesthesia, patient positioning and preparation, and local anesthetic selection. Spinal anesthesia offers distinct advantages for outpatient arthroplasty, including rapid onset, favorable operative conditions, and facilitation of same-day discharge. The video serves as a practical educational tool that reinforces evidence-based anesthetic practice and supports the continued advancement of safe, efficient care in ambulatory joint replacement surgery.
Total Knee Arthroplasty
Thomas S. Thornhill, MD; David J. Lee, MD
Brigham and Women’s Hospital
Total knee replacement is one of the most common orthopaedic procedures performed in the United States. The most common indication for total knee replacement is osteoarthritis. Clinical signs of knee osteoarthritis include pain with walking, difficulty ranging the knee, knee instability, varus deformity, bony enlargement, extension lag, and flexion contracture. Radiologic evidence for osteoarthritis of the knee includes the presence of osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts, and malalignment.
Before considering total knee replacement, patients typically undergo a trial of less invasive treatments, including lifestyle modification, pharmacologic therapy, and injections. If these methods fail to produce satisfactory improvement in the patient’s symptoms, one should consider the benefits and risks of total knee replacement in conjunction with their surgeon. Outcomes following total knee replacement are excellent, with patients reporting greatly reduced pain, improved mobility, and improved quality of life. However, patients must be aware that there are serious risks that accompany any surgery, which include infection, pulmonary embolism, deep vein thrombosis, nerve damage, and need for further procedures.
Mako Robotic Arm Assisted Total Knee Arthroplasty
Tufts Medical Center
Jeffrey S. Zarin, MD
Chief, Division of Arthroplasty
In this case a 66-year-old patient presents with arthritis predominantly in the medial compartment. Dr. Jeffrey Zarin explains how to use the Mako robot to precisely plan and perform a total knee arthroplasty surgery on this patient. Preoperatively, he uses a CT scan to create a model of the patient in order to determine the appropriate implant size, and intraoperatively, he utilizes the Mako robot to assist in ligament and gap balancing, perform the osteotomies, and make precise corrections.
The New Gold Standard for Surgical Videos