Sara82
Guru
Having a hard time with this surgery. would I code 27447-52 modifier or 27335? Any help would be appriciated than you.
POSTOPERATIVE DIAGNOSIS:
Osteoarthritis and apparent indolent infection, right knee.
INDICATIONS FOR SURGERY:
The patient is a 69-year-old gentleman known to me for quite some time with his knee arthritis. He continued to have severe right knee pain. At some point, probably the last six to nine months, he began to have more pain and more swelling in the knee. Twice we aspirated his knee in the office and just because it looked a little bit cloudy sent this off for culture and cell count. Both times it was negative. He ultimately came to total knee replacement.
DESCRIPTION OF OPERATION:
He had a very large effusion which was obvious before the surgery. No
significant warmth. We opened up his joint and a large amount of effusion was evacuated. It was relatively benign-appearing yellowish fluid, maybe a little bit cloudy. Very reactive synovium. We then did a complete synovectomy and removed all the slimy sort of tissue. Cultures were taken upon entering the joint. We also took a segment from the suprapatellar pouch and sent this off for frozen section. This was called back as really polys per high-power field too numerous to count, maybe as many as 50 or 60. This was
felt to all be consistent with infection. It was a very odd clinical story,but at that point we really felt that we needed to do a thorough debridement.
He had some cysts in the bone. His cartilage was gone and his overall knee had just a ton of fluid and reactive synovium and almost fibrinous-type look to the synovium. We made the decision at that point to do an articulating spacer just to get local antibiotics and get rid of his nonviable-appearing cartilage and distal bone and cyst. For that reason, we proceeded with removing the ACL and
PCL. A minimal tibial cut was made just to remove the cartilaginous surfaces on the top. This femur canal was opened up. We sized the femur to a large, but actually cut anteriorly a bit conservative and then moved the block posteriorly and cut posteriorly at least 2.5 mm conservative as well. This enabled us just to get the cartilage off. A distal cut was made in 5 degrees valgus as well and chamfers were just sort of free handed minorly to accommodate the implant. This enabled us to get to the back of the knee and continue our complete synovectomy around the back of the knee. A lot of fluid
was brought out of what was probably a Baker cyst posteriorly as well. We irrigated a couple of liters of antibiotic fluid solution as we went back and forth removing the synovium, the osteophytes, and the rest of the tissue. It cleaned up quite nicely and we had a good fit with the Exactech large spacer.The knee would come out to full extension and flex reasonably well.
POSTOPERATIVE DIAGNOSIS:
Osteoarthritis and apparent indolent infection, right knee.
INDICATIONS FOR SURGERY:
The patient is a 69-year-old gentleman known to me for quite some time with his knee arthritis. He continued to have severe right knee pain. At some point, probably the last six to nine months, he began to have more pain and more swelling in the knee. Twice we aspirated his knee in the office and just because it looked a little bit cloudy sent this off for culture and cell count. Both times it was negative. He ultimately came to total knee replacement.
DESCRIPTION OF OPERATION:
He had a very large effusion which was obvious before the surgery. No
significant warmth. We opened up his joint and a large amount of effusion was evacuated. It was relatively benign-appearing yellowish fluid, maybe a little bit cloudy. Very reactive synovium. We then did a complete synovectomy and removed all the slimy sort of tissue. Cultures were taken upon entering the joint. We also took a segment from the suprapatellar pouch and sent this off for frozen section. This was called back as really polys per high-power field too numerous to count, maybe as many as 50 or 60. This was
felt to all be consistent with infection. It was a very odd clinical story,but at that point we really felt that we needed to do a thorough debridement.
He had some cysts in the bone. His cartilage was gone and his overall knee had just a ton of fluid and reactive synovium and almost fibrinous-type look to the synovium. We made the decision at that point to do an articulating spacer just to get local antibiotics and get rid of his nonviable-appearing cartilage and distal bone and cyst. For that reason, we proceeded with removing the ACL and
PCL. A minimal tibial cut was made just to remove the cartilaginous surfaces on the top. This femur canal was opened up. We sized the femur to a large, but actually cut anteriorly a bit conservative and then moved the block posteriorly and cut posteriorly at least 2.5 mm conservative as well. This enabled us just to get the cartilage off. A distal cut was made in 5 degrees valgus as well and chamfers were just sort of free handed minorly to accommodate the implant. This enabled us to get to the back of the knee and continue our complete synovectomy around the back of the knee. A lot of fluid
was brought out of what was probably a Baker cyst posteriorly as well. We irrigated a couple of liters of antibiotic fluid solution as we went back and forth removing the synovium, the osteophytes, and the rest of the tissue. It cleaned up quite nicely and we had a good fit with the Exactech large spacer.The knee would come out to full extension and flex reasonably well.