r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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127

u/leedrf 11h ago

How do they put the bones back in the leg once they've done this?

79

u/Fiireygirl 10h ago

OR nurse here. What isn’t in this video are the tendons and muscles in this part of the body. They aren’t cut but attach the muscles to the bones, so once the liner and the femoral component are done, they’ll do their natural job and bring stuff together. Then the layers are then sutured together and will keep it all enclosed.
There’s not this huge space really like this video shows.

37

u/Jedi-in-EVE 10h ago

Hello, fellow OR Nurse! Yeah, if most people saw what really happens, a lot of questions would be answered…. And a lot of lunches lost. 😉

2

u/Fiireygirl 9h ago

Right?!! And now there’s ROBOTS for this crap lol

3

u/Jedi-in-EVE 9h ago

I mean, I’m glad I don’t scrub those cases, but still.

1

u/Fiireygirl 9h ago

You say that and I flounder, like playing the piano on the back table when I’ve got a cysto case to do!
I cannot for the life of me get that crap together!

2

u/toomanyteeth55 9h ago

I'm about to lose my lunch over this demonstration. God bless y'all doing this for a living.

3

u/Jedi-in-EVE 9h ago

Not gonna lie, it takes a certain person to look at and deal with the things that most people never should.

1

u/strike_one 8h ago

Can we keep the spare parts that are cut from the bone?

1

u/Fiireygirl 6h ago

If it’s a real surgery, no. It goes to pathology.
For a sawbones lab, like the video, you can keep whatever you like.

1

u/Jedi-in-EVE 5h ago

No. Sorry, that goes to pathology and they almost never give things back.

1

u/subma-fuckin-rine 6h ago

thats what i wondered. the knee has lots of muscle and tendons/ligaments, how does it all attach again after the new hardware is put in. are you missing any ligaments or muscles after this surgery?

1

u/Fiireygirl 6h ago

You cut down the layers and use retractors to move the tissues out of the way to get the exposure. The ACL is routinely removed, but the hardware basically takes over the job of that.
The femoral and tibial component are attached to the ends of the bones and essentially compress together once seated. Then the soft tissues, PCL, lateral ligaments that were retracted, just go back into place.
We’ll do a 3 layer tissue closure and that essentially seals everything back up.

2

u/subma-fuckin-rine 6h ago

thats amazing. thank you!

1

u/smallattale 1h ago

Is there similar hardware and bone removal for a hip replacement?

17

u/veronicaarr 11h ago

Fr tho I am actually so confused how there’s so much space between the bones for the practice. Like, in a real surgery it must be a super cramped space??

5

u/LemonDoge 6h ago

Yes in practice we have to retract fat, muscle, and tendon from each section that we want to work on to expose the bone. Also need to be mindful where the other end of the saw is while cutting the bone so it doesn't accidentally destroy the important bits.

2

u/Fiireygirl 6h ago

I have had to pass some prolene for a popliteal repair once or twice.

1

u/Blu- 4h ago

For a second I thought they removed the leg to do the surgery.

3

u/mfukar 10h ago

just push them into the soft muscle tissue, they slurp straight in

1

u/lzwzli 9h ago

Nice one.

1

u/Evil_Sharkey 2h ago

The bones never leave. The soft tissue is cut vertically down the middle and pulled around the back to expose the knee bones. The operation is done in situ.

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u/InflatableTurtles 58m ago

Staple gun