Infected hemiarthroplasty with complications

mdwyer

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I am having some issues trying to come up with the correct procedure codes based on the OP below:

PRE & POSTOP DX: Infected left hip hemiarthroplasty

OPERATION:
1. Incision & drainage
2. Irrigation and debridement
3. Removal of left hip hemiarthroplasty with use of fluoroscopy
4. Placement of antibiotic spacer.

COMPLICATIONS: Femur fracture

INDICATIONS: Patient underwent left hip hemiarthroplasty for a femoral neck fracture without complication approximately three weeks prior. Started developing pain in left hip and had discharge from wound that started on day of procedure. Advised to undergo irrigation and debridement and depending on how deep the infection would be she may need to have femoral head removed and changed. The surgery was about at the 3 week mark and it was felt therefore that the components could be retained if they were not loose.

PROCEDURE: After anesthesia, the left hip was prepped and draped in sterile manner. Upon completeion of prepping and draping, the previous incision was incised. A large amount of purulence was encountered and this was cultured. The infection communicated with the femoral prosthesis. The hip was then dislocated. The femoral head was disimpacted with 1 strike of the femoral head. The entire component was loose and slid out. The cement had debonded from the prosthesis. It was therefore decided at this point that the cement needed to be removed as well. Utilizing osteotomes and currettes, the methyl methacrylate was attempted to be removed. This was not successfully removed as it had bonded strongly to the medullary canal of the femur. A femur fracture had been noted and it extended down approximately halfway down the length of the femoral implant. It was therefore decided that an extended osteotomy should be performed to help remove this cement mantel. Therefore, the osteotomy was made and the cement was then removed. Multiple cables were placed at this point. Once this had been completed, the methyl methacrylate was mixed with Gentamicin and added vancomycin and tobramycin. Once this had been completed and a prosthetic insert was fashioned then the hip was then attempted to be reduced and a second fracture was identified at the distal most level of where the implant had been at the level of the cement restrictor. It was therefore decided that a cable plate system should be utilized and cable plating was then placed. Once this was felt to be solid, a large amount of irrigation which included Bacitracin and pulsatile lavage was placed, this was 6 liters. Methyl methacrylate spacer was then placed in the acetabulum in the proximal femur. Once this had been completed the incision was closed with #5 Ethibond suture followed by #2-0 Vicryl suture and 3-0 nylon and skin staples. Dry sterile dressing was applied.

Any help would be greatly appreciated!
 
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