DOCSLIB.ORG

Periacetabular Osteotomy for Developmental Hip Dysplasia with Labral Tears: Is Arthrotomy Or Arthroscopy Required? Songkiat Thanacharoenpanich1, Matthew J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Periacetabular Osteotomy for Developmental Hip Dysplasia with Labral Tears: Is Arthrotomy Or Arthroscopy Required? Songkiat Thanacharoenpanich1, Matthew J Journal of Hip Preservation Surgery Vol. 5, No. 1, pp. 23–33 doi: 10.1093/jhps/hnx048 Advance Access Publication 11 January 2018 Research article Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required? Songkiat Thanacharoenpanich1, Matthew J. Boyle2, Robert F. Murphy3, Patricia E. Miller4, Michael B. Millis4, Young-Jo Kim4 and Yi-Meng Yen4* 1Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand 10500, 2Department of Orthopaedics, Starship Children’s Hospital, Grafton, Auckland 1023, New Zealand, 3Department of Orthopaedics, Medical University of South Carolina, Charleston, SC 29425, USA and 4Department of Orthopaedics, Boston Children’s Hospital, Boston, MA 02115-5724, USA *Correspondence to: Y.-M. Yen. E-mail: [email protected] Submitted 26 April 2017; revised version accepted 19 December 2017 ABSTRACT Patients with developmental dysplasia of the hip (DDH) who undergo periacetabular osteotomy (PAO) often have labral tears. The objective of this retrospective study was to compare PAO alone with PAO combined with arthrotomy or arthroscopy in DDH patients who had a full-thickness labral tear on magnetic resonance imaging. In total, 47 hips in the PAO group (PAO) were compared with 60 hips in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) with respect to Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS), clinical and radiographic outcomes at a median of 29 months. Reoperation rate and complications were compared between two groups of treatment. The PAO group was younger than the PAO-A group (25.2 6 9.7 versus 31.3 6 8.3). The PAO group was more likely to have worse dysplasia: lateral center edge angle (7.669.63 versus 10.866.85) and anterior center edge angle (4612.92 versus 10.869.92). The PAO group had a higher preoperative mHHS (65.2 6 15.3 versus 57.8 6 14.8) and HOOS (66.3 6 17.5 versus 55.8 6 20.1). There were no significant differences in final func- tional outcome scores across treatment groups: mHHS (PAO; 86.8 6 12.4 versus PAO-A, 83.3 6 17.2), HOOS (86.5 6 13.3 versus 82.5 6 16.8) and VAS (2.5 6 2.8 versus 2.5 6 3.1). There was no difference in reoperation rate between two groups (6.4% versus 11.6%, P 0.51). The overall complication rate was lower in the PAO ¼ group (26% versus 68%), but major complications were comparable. On the basis of our data, we were not able to conclusively demonstrate a clear benefit for the routine treatment of all labral tears; however, arthrotomy or arthroscopy may play a role in some conditions. BACKGROUND articular cartilage damage. The Bernese periacetabular Developmental dysplasia of the hip (DDH) is one of the osteotomy (PAO) is an effective surgical treatment for more common causes of hip osteoarthritis in young adults. symptomatic DDH that reorients the dysplastic acetabu- The bony acetabulum in patients with DDH is abnormally lum resulting in improved hip stability, femoral head cover- shallow, often resulting in labral hypertrophy and forcing age and joint biomechanics [6–9]. Satisfactory outcomes the acetabular labrum to play a larger role in weightbearing have been reported following PAO, with a hip preservation and joint stability, which may eventually lead to tensile rate of 76% at 9 years postoperatively [10] and 60% at labral failure [1–5]. The weightbearing area of acetabular 20 years postoperatively [11]. cartilage is correspondingly reduced resulting in increased Labral pathology is common in patients with DDH, with cartilage contact forces which can lead to progressive labral tears reported in 60–100% of patients undergoing VC The Author(s) 2018. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] 23 Downloaded from https://academic.oup.com/jhps/article-abstract/5/1/23/4799057 by guest on 14 July 2018 24 S. Thanacharoenpanich et al. PAO [1, 5]. Labral tears contribute to mechanical symp- pathology (PAO), and Group 2 (60 hips): patients toms and the generation of hip pain in affected patients. who underwent PAO with concomitant arthrotomy or Although PAO has become the mainstay of surgical treat- arthroscopy for evaluation and treatment of intra-articular ment of symptomatic DDH, the ideal management of asso- pathology (PAO-A). In the PAO-A group, 43 hips under- ciated labral tears is less clear. A PAO biomechanically went PAO with arthrotomy whereas 17 hips underwent offloads the damaged labrum, potentially rendering labral PAO with arthroscopy. The two groups were compared pathology obsolete; many studies have reported satisfac- preoperatively and at final follow-up with respect to tory outcomes after isolated PAO despite the high rates of clinical assessment, radiographic analysis and functional labral pathology in this population [11, 12]. Alternatively, scores [Harris Hip Score (HHS), Hip Disability and PAO may be combined with hip arthrotomy or arthro- Osteoarthritis Outcome Score (HOOS) subscales and scopy to directly assess and treat labral pathology [5, 9, 10, Western Ontario and McMaster Universities Osteoarthritis 13–15]; however, the indications and necessity of these Index (WOMAC)]. Patients were followed for a mean of additional procedures are unclear. Two reports on arthro- 28.11 6 14.3 months following PAO. scopic treatment of labral pathology after PAO showed Indications for PAO included a minimum of 3 months modest clinical improvement after arthroscopic surgery of hip and/or groin pain aggravated by activity, despite [16, 17], suggesting that it may be beneficial to treat labral non-operative management, with radiographic evidence of pathology at the time of PAO. Patients that underwent a acetabular dysplasia based on a lateral center-edge angle concomitant arthroscopy for labral pathology at the time (LCEA) <20 on an anteroposterior pelvic plain radio- of the PAO had slightly greater improvements in short- graph and/or an anterior center-edge angle (ACEA) <20 term clinical outcomes compared with the PAO alone on a false profile view. Indications for combined PAO and group in a recent study [14]. hip arthroscopy included the prior in addition to a painful, There is currently a paucity of information available mechanical sensation reported by the patient with hip comparing PAO alone to treatment of labral pathology and motion and activity. Indications for combined PAO and PAO in patients with symptomatic DDH and labral tears. hip arthrotomy included the prior in addition to <10 of The purpose of this study was to compare the clinical, hip internal rotation with the hip in 90 of flexion intra- radiographic and functional outcomes after PAO with operatively after repositioning of the acetabular fragment. those after PAO combined with hip arthroscopy or arthrot- omy in patients with DDH and full-thickness labral tears Surgical technique on preoperative magnetic resonance imaging (MRI) The surgeries were performed by three surgeons; Surgeon arthrogram. We hypothesized that PAO combined with A performed PAO in addition to hip arthroscopy or hip arthroscopy or arthotomy would demonstrate superior arthrotomy when indicated, Surgeon B performed PAO in outcomes compared with PAO alone. addition to hip arthrotomy when indicated, and Surgeon C performed hip arthroscopy only. Hip arthroscopy was per- MATERIALS AND METHODS formed immediately prior to PAO in selected patients using a two-portal technique and a supine traction table as Patient selection previously described [18]. Central and peripheral compart- This study is a retrospective review of prospectively col- ments were treated, including labral repair with suture lected study data. Following institutional review board anchors, labral debridement and/or osteochondroplasty of approval, a series of 429 patients with DDH who underwent the femoral head neck junction, followed by capsular clo- PAO at our institution during April 2009–December 2014 sure with absorbable suture. PAO was performed according were identified. Study inclusion criteria consisted of skele- to a previously described technique [19, 20] through an tally mature DDH patients with a full thickness labral tear anterior modified Smith Petersen approach. When an on preoperative MR arthogram (defined as contrast com- arthrotomy was indicated, the direct and reflected heads of pletely traversing the labrum on at least one image) with a rectus femoris were detached and an anterior arthrotomy minimum of 1 year of follow-up after surgery. Exclusion cri- was performed. The joint was visually inspected, and the teria included any syndromic form of hip dysplasia and central compartment was treated with labral repair using those who had incomplete data. After exclusions, a total of sutures or suture anchors or labral debridement. An osteo- 107 hips in 82 patients were enrolled into the final cohort. chondroplasty of the femoral head neck junction was per- Included patients were allocated into two groups; formed to regain internal rotation, followed by capsular Group 1 (47 hips): patients who underwent PAO alone closure with absorbable suture and rectus femoris tendon without joint inspection and without addressing labral repair with non-absorbable suture. Downloaded from https://academic.oup.com/jhps/article-abstract/5/1/23/4799057 by guest on 14 July 2018 PAO for DDH with labral tears 25 Postoperatively, all patients were instructed to use when data deviated from normality. These characteristics crutches with partial weight bearing for the first 6–8 weeks were compared across treatment groups using chi-squared after surgery until radiographic healing was confirmed. tests for categorical and binary variables and Student’s t-test Physical therapy was recommended after the 6- or 8-week or the Mann–Whitney U-test for continuous variables.
Load more

Recommended publications
  • Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children by MININDER S
    COPYRIGHT © 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children BY MININDER S. KOCHER, MD, MPH, RAHUL MANDIGA, BS, DAVID ZURAKOWSKI, PHD, CAROL BARNEWOLT, MD, AND JAMES R. KASSER, MD Investigation performed at the Departments of Orthopaedic Surgery, Biostatistics, and Radiology, Children’s Hospital, Boston, Massachusetts Background: The differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. The purpose of the present study was to validate a previously published clinical prediction rule for this differentiation in a new patient population. Methods: We prospectively studied children who presented to a major children’s hospital between 1997 and 2002 with an acutely irritable hip. As in the previous study, diagnoses of septic arthritis (fifty-one patients) and transient synovitis (103 patients) were operationally defined on the basis of the white blood-cell count in the joint fluid, the re- sults of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression were used to compare the two groups. The predicted probability of septic arthritis of the hip from the prediction rule was compared with actual distributions in the current patient population. The area under the receiver operating char- acteristic curve was determined. Results: The same four independent predictors of septic arthritis of the hip (a history of fever, non-weight-bearing, an erythrocyte sedimentation rate of 40 mm/hr, and a serum white blood-cell count of >12,000 cells/mm3 (>12.0 × 109/L)) were identified in the current patient population.
    [Show full text]
  • Knee Joint Surgery: Open Synovectomy
    Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Synovectomy POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5588 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from HealthHelp.
    [Show full text]
  • Ankle and Pantalar Arthrodesis
    ANKLE AND PANTALAR ARTHRODESIS George E. Quill, Jr., M.D. In: Foot and Ankle Disorders Edited by Mark S. Myerson, M.D. Since reports in the late 19th Century, arthrodesis has been a successful accepted treatment method for painful disorders of the ankle, subtalar, and transverse tarsal joints. While the title of this chapter involves arthrodesis - the intentional fusion of a joint - as a form of reconstruction, this chapter will address not only surgical technique, but nonoperative methods of care as well. We will address the pathophysiology leading to ankle and hindfoot disability, succinctly review the existing literature on the topic of hindfoot and ankle arthrodesis, highlight the pathomechanics involved, and spend considerable time on establishing the diagnosis, indications, and preoperative planning when surgery is indicated. We also will discuss the rehabilitation of the postoperative patient, as well as the management of complications that may arise after ankle and pantalar arthrodesis. There are more than thirty different viable techniques that have been described in order to achieve successful ankle and hindfoot arthrodesis. It is not the purpose of this chapter to serve as compendium of all the techniques ever described. The author will, rather, attempt to distill into a useful amount of clinically applicable material this vast body of information that the literature and clinical experience provide. Ankle arthrodesis is defined as surgical fusion of the tibia to the talus. Surgical fusion of the ankle (tibiotalar) and subtalar (talocalcaneal) joints at the same operative sitting is termed tibiotalocalcaneal arthrodesis. Fusion of the talus to all the bones articulating with it (distal tibia, calcaneus, navicular, and cuboid) is termed pantalar arthrodesis.
    [Show full text]
  • Knee Joint Surgery: Open Arthodesis of the Knee, Unspecified
    Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Arthodesis of the knee, unspecified POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5623 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission
    [Show full text]
  • DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
    DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment.
    [Show full text]
  • Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures
    SCIENTIFIC ARTICLE Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures Paul W. L. ten Berg, MSc, Chaitanya S. Mudgal, MD, Matthew I. Leibman, MD, Mark R. Belsky, MD, David E. Ruchelsman, MD Purpose Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-di- mensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. Methods We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm2) and subchondral volumes (mm3) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. Results Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm2; through the coronal plane arc (45°), 129 mm2, and through the sagittal plane arc (120°), 265 mm2. The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm3. Mean subchondral volume occupied by the countersunk portion was 4%. The phalan- geal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc.
    [Show full text]
  • CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019
    CLINICAL GUIDELINES CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019 Clinical guidelines for medical necessity review of speech therapy services. © 2019 eviCore healthcare. All rights reserved. Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314: Hip Surgery-Arthroscopic and Open Procedures CMM-314.1: Definitions 3 CMM-314.2: General Guidelines 4 CMM-314.3: Indications and Non-Indications 4 CMM-314.4 Experimental, Investigational, or Unproven 6 CMM-314.5: Procedure (CPT®) Codes 7 CMM-314.6: References 10 © 2019 eviCore healthcare. All rights reserved. Page 2 of 13 400 Buckwalter Place Boulevard, Bluffton, SC 29910 • (800) 918-8924 www.eviCore.com Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314.1: Definitions Femoroacetabular Impingement (FAI) is an anatomical mismatch between the head of the femur and the acetabulum resulting in compression of the labrum or articular cartilage during flexion. The mismatch can arise from subtle morphologic alterations in the anatomy or orientation of the ball-and-socket components (for example, a bony prominence at the head-neck junction or acetabular over-coverage) with articular cartilage damage initially occurring from abutment of the femoral neck against the acetabular rim, typically at the anterosui per or aspect of the acetabulum. Although hip joints can possess the morphologic features of FAI without symptoms, FAI may become pathologic with repetitive movement and/or increased force on the hip joint. High-demand activities may also result in pathologic impingement in hips with normal morphology. s It ha been proposed that impingement with damage to the labrum and/or acetabulum is a causative factor in the development of hip osteoarthritis, and that as many as half of cases currently categorized as primary osteoarthritis may have an etiology of FAI.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Knee Replacement Surgery (Arthroplasty), Total and Partial
    UnitedHealthcare® Commercial Medical Policy Surgery of the Knee Policy Number: 2021T0553S Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policy Coverage Rationale ........................................................................... 1 • Unicondylar Spacer Devices for Treatment of Pain Documentation Requirements......................................................... 1 or Disability Definitions ........................................................................................... 2 Community Plan Policy Applicable Codes .............................................................................. 2 • Surgery of the Knee U.S. Food and Drug Administration ................................................ 3 References ......................................................................................... 4 Medicare Advantage Coverage Summary Policy History/Revision Information................................................ 4 • Joints and Joint Procedures Instructions for Use ........................................................................... 5 Coverage Rationale Surgery of the Knee is proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® 2021, Apr. 2021 Release, CP: Procedures: • Arthroscopy, Diagnostic, +/- Synovial Biopsy, Knee • Arthroscopy or Arthroscopically Assisted Surgery, Knee • Arthrotomy, Knee • Total Joint Replacement (TJR), Knee • Removal and Replacement, Total Joint Replacement (TJR),
    [Show full text]
  • Master List of All CPT to Include Claims Only Codes for Any UM
    Prominence Health Plan: Joint Surgery CPT Code List Category CPT® Code CPT® Code Description Joint Surgery Mgmt 23120 Claviculectomy; partial Joint Surgery Mgmt 23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release Joint Surgery Mgmt 23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Joint Surgery Mgmt 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic Joint Surgery Mgmt 23415 Coracoacromial ligament release, with or without acromioplasty Joint Surgery Mgmt 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Joint Surgery Mgmt 23430 Tenodesis of long tendon of biceps Joint Surgery Mgmt 23440 Resection or transplantation of long tendon of biceps Joint Surgery Mgmt 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation Joint Surgery Mgmt 23455 Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure) Joint Surgery Mgmt 23462 Capsulorrhaphy, anterior, any type; with coracoid process transfer Updated: 6/12/2018 Category CPT® Code CPT® Code Description Joint Surgery Mgmt 23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability Joint Surgery Mgmt 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, Joint Surgery Mgmt 23472 total shoulder)) Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid Joint
    [Show full text]
  • Arthroscopy at AESC, We Are Proud to Offer Arthroscopy (Also Called
    Arthroscopy At AESC, we are proud to offer arthroscopy (also called arthroscopic surgery), a new surgical procedure that allows us to evaluate and sometimes treat the inside of a joint in a minimally invasive fashion. It is a surgical procedure that uses a tiny viewing instrument called an ‘arthroscope’ that acts as a camera in conjunction with arthroscopic instruments (if treatment is needed). The surgical instruments used are much smaller than traditional instruments and instead of looking at the joint directly we view the joint area on a video monitor. During arthroscopy only two small incisions are made - one for the arthroscope and one for the surgical instrument(s). This minimally invasive surgery has a multitude of advantages over the conventional joint surgery of ‘arthrotomy’ (which means to fully open up the joint by an open approach through the muscles and an incision through the joint capsule). Some of those advantages include: • Due to the smaller size of the incisions, arthroscopy is less painful for the patient and allows for quicker recovery. • Due to the magnification provided with the camera, assessment of the joint is more complete and accurate. • The smaller approach causes less tissue trauma and therefore produces less scar tissue while the tissues are healing. • Due to the smaller approach, some of the complications associated with an open procedure (such as patella luxation after knee arthrotomy) can be avoided. Arthroscopy can be used to diagnose and sometimes also treat a joint problem. At AESC we commonly use arthroscopy for: • Confirmation of a tear of the cranial cruciate ligament in the knee • Treatment of meniscal injuries in the knee • Treatment of fragmentation of the coronoid process in the elbow (FCP) • Removal of cartilage flaps (OCD-lesions) from the shoulder, hock, knee and elbow • Assessment of the hip joint to evaluate the animal as a candidate for a Triple Pelvic Osteotomy (TPO) Complications from arthroscopy are rare.
    [Show full text]
  • Hip Joint Surgery: Arthrotomy for Biopsy of the Sacroiliac Joint Or Hip Joint
    Musculoskeletal Surgical Services: Hip Joint Surgery: Arthrotomy for biopsy of the sacroiliac joint or hip joint POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5629 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from
    [Show full text]