Wiki Shoulder- Removal of failed hemi - to a total shoulder


Rothbury, MI
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I am not sure which way to code this one. The patient had a hemi arthroplasty and it failed so they decided to remove the hemi and do a total shoulder. There are no conversion codes and even if there were I don't know if it would apply here because the humeral was a revision and the glenoid was a new replacement. Would you just code a total shoulder with a 22 or a revision?

PREOPERATIVE DIAGNOSIS: failed Left shoulder hemiarthroplasyt, anterior superior escape, glenoid based pain

Biomet comprehensive reverse total shoulder system
Mini baseplate with 35mm central screw
Peripheral screws, 35 superior, 40 inferior, 20 anterior
36 std glenosphere dialed to B offset
Std humeral tray with 36 std poly liner

INDICATIONS: This is a 52-year-old female with left shoulder pain and limited function and motion secondary to above diagnosis. They have failed conservative treatment and after a discussion of risks, benefits, and alternatives, wished to proceed with revision shoulder arthroplasty.

DESCRIPTION OF PROCEDURE: On the day of surgery, the patient identified the left shoulder as the correct operative extremity. This was initialed by the surgeon with the patients's acknowledgment. The patient underwent placement of an interscalene block and was taken to the operating room and placed in the supine position. Upon induction of adequate anesthesia, the patient was brought up to the beach chair position and the shoulder and upper extremity were prepped and draped in the usual sterile fashion. Timeout confirmed the correct patient and operative extremity as well as that antibiotics were on board. A standard deltopectoral approach to the shoulder was carried out. It was carried sharply through the skin and subcutaneous tissue. Medial and lateral flaps were developed over the deltopectoral fascia. The cephalic vein was identified and mobilized laterally with the deltoid. The subdeltoid and subpectoral spaces were mobilized and a blunt retractor was placed deep to this. The clavipectoral fascia was opened on the lateral edge of the conjoined tendon and the retractor was moved deep to this. The leading edge of the pectoralis was released . The inferior capsule was released directly off the humerus to allow greater than 90° of external rotation. The prior humeral head was extracted without difficulty, no signs of humeral stem loosening or synovitic tissue was notable. . The humerus was subluxed posteriorly. The glenoid exposed. The central guidepin was placed using the guide. The glenoid was gently reamed and then the central hole for the baseplate was drilled glenoid baseplate inserted. Screws were then placed through the baseplate The glenosphere was then inserted and locked into place The humerus was carefully subluxed back anteriorly. A liner tray and polyethylene were placed and trialing was carried out. The appropriate final sizes were chosen and locked into place. The shoulder was then reduced. This allowed nearly full passive range of motion with no instability. The joint was copiously irrigated with orthopedic irrigation after the final implants were assembled and locked into place.