deborahcook4040
Networker
my MD wants to use an unlisted procedure code for this, but I'm thinking an exploration of hip joint (CPT 27033) pretty much covers it. Looking for a second opinion.
Some history, pt has had hip replacement for several years, has a recurring non-reducible dislocation, had revision surgery a year ago and an attempted reduction under anesthesia 3 days previous to this. Op report is as follows:
"The fascia was opened in the direction of the incision . A
moderate amount of hematoma was evacuated from around the hip. A self- retaining retractor was placed, and the incision was extended distally to get better exposure of the proximal femur. She was immediately noted to have had a fracture involving the greater trochanter which was w s displaced. The femoral prosthesis was readily exposed; and in fact, She had comminution of the fracture fragments around the prosthesis itself. The prosthesis did not appear to be loose distally; and this was a fully porous-coated prosthesis, so was well-fixed from the original surgery. There was, however, bone loss surrounding the prosthesis, some of which was due to osteolysis.
At that point, the femoral head was removed; and the hip was better exposed. However, the acetabular component appeared to be in good anteverted position. There was w a 10-degree offset polyethylene liner in
place; and in order to remove the acetabular component, there would have been significant bone loss from the pelvis. Since she already had a compromise of the femoral component, it was s decided simply to replace the femoral head, which was impacted onto the Morse taper of the femoral neck without difficulty. The hip was then reduced; and in order to reapproximate the greater trochanter, the leg would have required internal rotation. It was, therefore, decided not to repair this because it would have made the hip even more unstable once it was reduced.
Therefore, after deliberation it was decided simply to irrigate the wound, and a Hemovac drain was placed through a separate stab incision anteriorly. The Gelfoam was inserted around the femoral canal to reduce the bleeding, but there was not enough ough bone in the proximal femur to even consider revising the prosthesis. Therefore, after irrigation, the fascia lata was closed with #1 vicryl running simple sutures in segments. The drain was attached to closed suction. The deeper subcutaneous tissue was closed with 0 Vicryl interrupted simple sutures followed by 2-0 Vicryl interrupted simple sutures and staples for the skin."
Some history, pt has had hip replacement for several years, has a recurring non-reducible dislocation, had revision surgery a year ago and an attempted reduction under anesthesia 3 days previous to this. Op report is as follows:
"The fascia was opened in the direction of the incision . A
moderate amount of hematoma was evacuated from around the hip. A self- retaining retractor was placed, and the incision was extended distally to get better exposure of the proximal femur. She was immediately noted to have had a fracture involving the greater trochanter which was w s displaced. The femoral prosthesis was readily exposed; and in fact, She had comminution of the fracture fragments around the prosthesis itself. The prosthesis did not appear to be loose distally; and this was a fully porous-coated prosthesis, so was well-fixed from the original surgery. There was, however, bone loss surrounding the prosthesis, some of which was due to osteolysis.
At that point, the femoral head was removed; and the hip was better exposed. However, the acetabular component appeared to be in good anteverted position. There was w a 10-degree offset polyethylene liner in
place; and in order to remove the acetabular component, there would have been significant bone loss from the pelvis. Since she already had a compromise of the femoral component, it was s decided simply to replace the femoral head, which was impacted onto the Morse taper of the femoral neck without difficulty. The hip was then reduced; and in order to reapproximate the greater trochanter, the leg would have required internal rotation. It was, therefore, decided not to repair this because it would have made the hip even more unstable once it was reduced.
Therefore, after deliberation it was decided simply to irrigate the wound, and a Hemovac drain was placed through a separate stab incision anteriorly. The Gelfoam was inserted around the femoral canal to reduce the bleeding, but there was not enough ough bone in the proximal femur to even consider revising the prosthesis. Therefore, after irrigation, the fascia lata was closed with #1 vicryl running simple sutures in segments. The drain was attached to closed suction. The deeper subcutaneous tissue was closed with 0 Vicryl interrupted simple sutures followed by 2-0 Vicryl interrupted simple sutures and staples for the skin."