The bee's knees

So far I have not had a whole lot of positives about my rotations, so I thought I should throw out some of the positive moments. I have to warn that a few of these things may be a little graphic in nature - sorry, that's just the way it is.

1. I've been scrubbing in on TKA's (total knee arthroplasty = joint replacement) why this is cool - I get to where the hood and helmet on top of the whole scrubbing in, gown and gloves. There are about 6 steps to a TKA (way simplified: Knee is suspended and a tourniquet is applied, A vertical incision is made from the upper part of the patella (kneecap) to just below the knee joint, about 4 to 6 inches. Traditional replacements are 8-10 inches, 3. About 1/4 inch is sawed off from the ends of the femur and tibia bones to prepare the surface, The under part of the kneecap is trimmed with a saw and fitted with plastic, The prosthesis is sized, then cemented (and/or) pressed into the bone, The deep tissues are stitched, and the skin is stitched or stapled.) It is a very messy procedure - bone and tissue flying here there everywhere - sometimes chunks land on the face shield of the hood and then slide down like a pickle on a window leaving a lovely smear - this was my experience last Friday. The hood itself is a process, first there's the helmet - thank goodness I ran into a girl PA on another case who gave me the wisest advice about the helmets - take out my pony tail. The helmet have a fan attached to the back to help keep you cool, the battery pack fits in the back pocket of the scrubs (so it's really important that your pants are tied tightly). The hood part slips over the helmet which is placed on by the scrub nurse who helps dress you as you enter the sterile field (and by dressing me I mean gown and gloves). It's really difficult to hear in the hoods - and unlike when wearing just a mask - everyone can see your entire face, so I have to pay special attention not to stand with my mouth open while intently watching. Well that's probably more than enough info about TKAs for now - here's a link to one of the main companies we use for the prosthetics: stryker triathalon http://www.stryker.com/en-us/products/Orthopaedics/KneeReplacement/Primary/Triathlon/index.htm

See the pics at the beginning of the post to see the hoods and pre and post op examples...

2. OR fashion. I know this might seem strange but there are really important things to know about scrubs, shoe covers and caps when selecting the ones you will be wearing all day. In the women's locker room there are two sets of shelves of blue scrubs. One set of tops and one bottoms- this is where is gets tricky. There are mens and womens scrubs, both available from S-XXL. The women's pants are elastic wastebanded and tapered - very tapered and the tops have a lovely modest neckline (not a V) with two pockets on the bottom on each side. The men's bottoms have a drawstring and are more of a relax fit straight leg type of pant. The tops have a V neck (not a plunging neckline, but a definite V) and one pocket on the left breast. Hats: women have cafeteria style blue bouffant caps (same one patients get) but they have regular and large sizes, men have the tie caps, and hats that extend to cover a beard. Shoe covers- an often overlooked necessity. There are the regular show covers - one size fits all and then there are the shoe covers that extend up tot he knee - essential when doing a knee arthroscopy when water is pouring all over the place, seriously it's like lake Huron in there when we're done. If you don't wear these - as I have found (although they never seem to be out of them in the locker room) your entire leg will be wet from water and a little bit of your shoes. May not seem too bad considering it rains all the time here - shoes get wet, no biggie, but then you realize the water came from inside the knee during the procedure.

Oh and here's a link of pics of an actual TKA procedure I found... it's a little gorey, be warned

http://www.genufix.com/total_knee_replacement_photos.htm
And here's a link for you to do a "virtual TKA" : http://www.edheads.org/activities/knee/

3. I got to inject a couple knees today one with Orthovisc and the other with Synvisc. whoohoo!!

Ok, I think that's probably enough for one post about a rotation...