another hip!

Amzie

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I am new to doing surgery coding still and need some assistance on this hip surgery. I dont get these very often so it can be tricky for me.

DX: Infected Rt total hip
Here is the procedure:

The patient was taken to the OR and induced under spinal anesthesia and then general. Moved to the left lateral decubitus position and a backpack pillow on the Jackson table. I made a long posterior incision extending the current posterior incision. We got a tremendous amount of fluid on entering the subcu, almost a liter and this was kind of a rose colored opaque, non foul smelling fluid. We sent this for culture. Unfortunately this gentleman has been on antibiotics for quite some time. He has grown out a staph epi that has become more resistand with the days of hospitalization. The subcu has large areas of dead space. We irrigated and curetted and I had previously placed PDS and Prolene on the tensor. We went through the previous sutures. At this pint I did not remove the spacer that exists between the frmoral componenet and the acetabular component, but rather used this aas a fulcrum so I could make an extended trochanteric osteotomy under fluoroscopic guidance and go down around this fully-coated stem. We moblizied the vastus lateralis about a centimeter anterior to the knee, aspirated it and leaving the tendinous portion. We used as well needle point drill to make many drill holes for the planned osteotomy. We were able to osteotomize cleanly in the entire upper portion until we got down to about the last 3 cm of the implant, we were not able to osteotomize that. We opend up the osteotomy laterally, found huge areas of glycocalyx and irregularly eaten endosteal bone. Obviously then stem will not come out and we made a decision at this point to free the stem from the acetabulum and removing the spacer. We then used curved osteotomes to remove the stem. This was slow, difficult and not done cleanly. We eventually removed the stem.
Unfortunately there were more despite cerclage wires being placed before the osteotomy, we still have cracks where we removed the stem, and I would say at least the distal 3 cm the stem are very well fixed to the femur and there is no fixation that I can tell anywhere else. Having removed the stem then we slowly used more instruments to remove the acetabular components. There were huge areas of glycocalyx behind what had been a well fixed acetabulum. We curettted these and the screw holes. We then fashioned a prosthesis out of three 9/16 threaded Steinmann pins, wiring these together with 18 gauge wire and then used three batches of Palacos mixed with 6 grames per batch of vancomycin and 2 grams per batch of tobramycin. We used the previous acetabular component to make the head portion of this and with a caliper we fashioned the femoral component to fit the previous stem, making the component first and then usinga bur to smooth it to match, checking the levels of the implant and taking the caliper to the prostalac and making sure the dimensions were similar, within 1 mm usually less. We then placed this in the acetabulum and the femur. We used no less than fourteen 18 gauge stainless steel wires to tighten the osteotomy and the unplanned crack distally around the impalnt. We did this under fluroroscopic guidance.

I am thinking that he removed the previous implants 27091 and then placed a spacer, 11983? Any suggestions would be great!

Thanks in advance
 

armen

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Atlanta
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I agree with previouse post since they have replaced both components.

27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft
 
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