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27130-52 Or 27299

  1. #1
    Default 27130-52 Or 27299
    Exam Training Packages
    PATIENT HAS CHRONIC SEPTIC ARTHRITIS

    PROSTHESIS:
    DEPUY PROSTALAC 42 BY 32 MM ALL POLY LINER
    DEPUY SIZE 2 PROSTALAC MOLD STEM
    32 MM COBALT CHROME HEAD WITH +5 MM NECK SEGMENT

    MODIFIED

    THE ANTERIOR ASPECT OF THE MEDIUS, MINIMUS AND CAPSULE WERE ELEVATED OFF THE ANTERIOR MEDIAL FEMORAL NECK, OPENING THE HIP JOINT. UPON ENTERING THE HIP JOINT THERE WAS SOME FAIRLY BENIGN APPEARING FLUID A LOT OF INFLAMATTION AND UNHAPPY TISSUE. CULTURES WERE TAKEN FROM THE HIP JOINT ITSELF. WE THEN PROCEEDED FURTHER EXPOSER. ONCE WE COULD DISLOCATED THE HIP WE DISLOCATED THE FEMORAL HEAD WHICH HAD A FAIR AMOUNT OF DAMAGE AND COLLAPS PRESENT. CUTTING ACROSS, THE LESSER TROCHANTER WAS IDENTIFIED AND THAT CUT WAS MAD IN KEEPING WITH OUR PREOPERATIVE PLAN.

    INSPECTING THE FEMORAL HEAD. THERE WAS SOME FATTY DETERIORATION OF THE CANCELLOUS STRUCTURE OF THE FEMORAL NECK ITSELF. A SECTION OF TISSUE WAS SENT TO THE LAB AS WELL AS CULTURES TAKEN FROM THE FEMORAL HEAD ITSELF. GIVEN THE AMOUNT OF INFLAMATTION WE PROCEEDED WITH THE STAGED PROCEDURE. WITH THE HEAD OUT OF THE WAY OUR ATTENTION WAS TURNED TO THE ACETABULUM. A LOT OF THE CAPSULE AND FIBROTIC INFLAMMED TISSUE WAS REMOVED FROM AROUND THA ACETABLUM. WE DID A LIGHT REAMING JUST TO REMOVE THE CARTILAGE AND GET A BONY SURFACE WHICH ULTIMATELY WAS A 50 MM REAMER. WE THEN ASSESED OUR ACETABULAR ALL POLYETHYLENE COMPONENT AND OUR OVERALL POSITION BASED ON LANDMARKS. ONCE WE WERE HAPPY WITH THIS WE CEMENTED THIS IN PLACE. TWO BAGS OF CEMENT WERE MIXED ON THE BACK TABLE WITH 3 GRAMS OF TOBRAMYCIN AND 1 GRAM OF ANCEF.......THE CEMENT WAS ALLOWED TO HARDEN IN THE ACETABULUM. WE TURNED OUR ATTENTION TO THE FEMUR THE CANAL WAS OPENED AND WE BROACHED WITH A 1 AND A 2 PROXIMAL BROACH. WE USED A 2 BROACH FOR POSITIONING AND TRAILING TO BE SURE WE HAD NOT OVER LENGTHENED AS WELL AS TO GET THE ANTEVERSION CORRECT. THIS WAS MARKED ON THE FEMUR AND AGAIN A MOLD WAS MADE ON THE BACK TABLE USING THE 2 PROSTALAC WITH THE SAME COMBINATION OF CEMENT ANTIBIOTICS. ONCE THIS WAS FORMED AND WUITE HARDENED IT WAS ABLE TO BE IMPACTED IN THE FEMUR....AFTER MULTIPLE TRIAL REDUCTIONS WE SETTLED ON A +5 MM BALL SEGMENT WHICH GAVE THE BEST COMBINATION OF STABILITY AND SOFT TISSUE TENSION............

    Please give me your feedback

    thanks

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I guess I have two questions for you

    Why do you feel the -52 would be indicated with the 27130?

    What prompts you to consider using the unlisted 27299 for this case?

    I feel like I missed something, but I have read this a couple of times and keep seeing the same thing.

  3. #3
    Default
    Well I Guess Because This Is Was Not A True Arthroplasty. My Doc Wanted To Use Just Bill Arthotomy For Infection And The Placement Of Antibiotic Spacer. He Made The Cuts For As If He Was Doing The Tkr But The Components Were Spacers. Does This Not Make A Dirfference? I Know Its More Than A 27030 But Not Sure If The Actual Tkr Could Be Billed?

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    that makes more sense. I could not tell my the implants listed that those were spacers, they appeared to be total hip components. Are they all antibiotic spacers?

  5. #5
    Default
    Yes Exept The Liner

  6. #6
    Default
    I'm Sorry Their Is A Chrome Ball Segment

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