tokens: 262912613 CTMC 43279523 551881 6/25/1990 12:00:00 AM Discharge Summary Signed DIS Admission Date : 06/25/1990 Report Status : Signed Discharge Date : 07/05/1990 PRINCIPLE DIAGNOSIS : LEFT KNEE OSTEOARTHRITIS . PROCEDURE : LEFT TOTAL KNEE ARTHROPLASTY ON 6/26/90 . HISTORY OF PRESENT ILLNESS : The patient is a 78-year-old female who has had osteoarthritis and noted the sudden onset of left knee pain in 09/89 . Since that time , she has used a cane and she was referred to Dr. Koors . MRI demonstrated a left femoral condyle osteonecrotic defect and degenerative meniscus . She climbs stairs one at a time and denied rest pain . She can one walk without difficulties . She presented for an elective left total knee arthroplasty . PAST MEDICAL HISTORY : Pneumonia one and a half years ago . Hepatitis 35 years ago . Anxiety neurosis for which she has received shock therapy in the past . PAST SURGICAL HISTORY : Total abdominal hysterectomy . MEDICATIONS : On admission included Tylenol . ALLERGIES : DOXEPIN CAUSES ITCHING . HABITS : The patient does not smoke . She drinks one to two glasses of scotch per day . PHYSICAL EXAMINATION : On admission was only significant for her orthopaedic exam . Her left knee had 5 degrees of valgus , 120 degrees of flexion , full extension and slight valgus instability . She had no Lachmann or anterior drawer , she did have a mild effusion . She had normal sensation and pulses in both legs . LABORATORY DATA : On admission included a hematocrit of 34.2 . Potassium 4.4 . HOSPITAL COURSE : The patient was cleared for surgery by Dr. Lupevickette Ca . Her EKG was normal . She was therefore taken to the Operating Room on 6/26 and underwent a left total knee arthroplasty losing 200 cc of blood in the procedure with two drains left in which were removed on the first postoperative day . She was slightly agitated on the first postoperative day but this resolved by the second postoperative day . Her epidural catheter was removed on 6/29 . The Foley catheter was removed on 6/29 and she had no difficulties voiding . Psychiatry Service saw her on 6/28 and recommended avoiding benzodiazepines and Haldol for agitation . She was prophylaxed with Kefzol perioperatively and with Coumadin postoperatively . She was also given whiskey spirits because of the fact that she drank one to two drinks of scotch per day . Her hematocrit was 31.4 on 6/29 with a PT of 18.2 Her PT drifted down to a level of 12.9 by 7/3 and therefore she will be discharged with 4 mg of Coumadin per day to be followed by the Coumadin Clinic at Cowerin Tonli Medical Center . She was discharged with a prescription for Tylenol #3 with Physical Therapy . She did quite well with Physical Therapy and was ambulating with a walker and crutches by 7/3/90 . She was able to flex her knees to 90 degrees by that time . She developed no problems with edema or with her wound during her hospital stay . She will follow-up with Dr. Koors in approximately five weeks . ________________________________ IA605/6041 DE KOORS , M.D. CU2 D : 07/03/90 Batch : 1726 Report : J0929X49 T : 07/04/90 Dicatated By : LENTNY FARSTNAPPSSHEE , M.D.