Mps planned size 2 insignia stem for 4.1 tha mako case.Reviewed plan with surgeon prior to him scrubbing in.While broaching with size 1, surgeon wanted to see a size 1 on mako plan, then continued to broach to a size 2 noting it was a better fit.Trailed with size 2.Landmarks captured, hip length longer than goal.Surgeon calcar reamed with size 1 broach and then did not return to size 2 broach while trailing.Continued on trailing with size 1 without mps knowledge.Presented size 2 insignia high offset implant box and head to surgeon, reading out parts and sizes.Surgeon looked up at boxes and acknowledged correct and to open boxes.No following landmarks were captured to attain final length and offset.Surgeon closed patient without concern.Card was handed to surgeon containing final length and offset numbers as well as implant stickers.Upon examining post op xr prior to patient leaving or, surgeon determined pt leg length to be longer than goal.Surgeon contacted mps noting he wanted a size 1 stem not a 2 and he wants to open patient up again and switch to size 1 stem.Pt was opened and stem was switched to size 1 from 2 and a new biolox 36mm +0 head was implanted.Upon further discussion with or manager, surgeon's pa noted final stem seemed to sit proud of trial and questioned size but surgeon was not concerned.Nurse and scrub techs recall mps calling out and presenting implants to surgeon.
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