Peroperative information Patient name* First Last Did the surgery take place today?* Yes No Surgery Date* MM slash DD slash YYYY Operated limb* Knee Hip Type of anesthesiaGeneralSpinalCombined Spinal EpiduralLoco regionalLIAOtherSurgery duration in MINUTES (skin to skin)Hip surgerySurgical approachAnteriorAntero lateralLateralPosterolateralSuperior/SuperpathOtherCemented? Yes No Hybrid Implant typeStandardResurfacingCeramic on CeramicCeramic on PEMetal on PEMetal on MetalKnee surgeryGarrot? Yes No Robot? Yes No Robot type Surgical approachPara-patellarSubvastusMidvastusPara-patellar lateralOtherWhich other approach? Cemented? Yes No Hybrid Implant typePosterior StabilizedCruciate retainedMedical pivotUni knee mobileUni knee fixedOtherWhich other implant type? Patella replacement? Yes No Final remark (optional)Optional remark Updated on January 28, 2022 Was this article helpful? Yes No Related Articles Medical protocol Still need help? Your Name* Your Email* Your Message*