DOCSLIB.ORG

Management of Complications After Reverse Shoulder Arthroplasty

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Complications After Reverse Shoulder Arthroplasty See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/270649975 Management of complications after reverse shoulder arthroplasty Article in Current Reviews in Musculoskeletal Medicine · January 2015 DOI: 10.1007/s12178-014-9252-9 CITATIONS READS 10 351 5 authors, including: Paul H Yi Xinning Li Johns Hopkins University Boston University 56 PUBLICATIONS 300 CITATIONS 104 PUBLICATIONS 867 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Commentary & Perspective Total Hip Arthroplasty View project All content following this page was uploaded by Xinning Li on 27 January 2015. The user has requested enhancement of the downloaded file. Curr Rev Musculoskelet Med DOI 10.1007/s12178-014-9252-9 SHOULDER SURGERY: COMPLICATIONS (X LI, SECTION EDITOR) Management of complications after reverse shoulder arthroplasty Hanbing S. Zhou & Justin S. Chung & Paul H. Yi & Xinning Li & Mark D. Price # Springer Science+Business Media New York 2015 Abstract Reverse total shoulder arthroplasty (RTSA) has Keywords Reverse shoulder arthroplasty . Complication . become the treatment of choice for patients with rotator cuff Management arthropathy. Complication rate after RTSA has been reported to be three to five times that of conventional total shoulder arthroplasty. Intraoperative and postoperative complications include neurological injury, infection, dislocation or instabil- Introduction (reverse total shoulder arthroplasty, ity, acromial or scapular spine fracture, hematoma, and scap- complications) ular notching. Knowledge of optimal component placement along with preoperative planning and recognition of risk The development of the reverse total shoulder arthroplasty factors are essential in optimizing patient outcome. The pur- (RTSA) in the late 1980s provided orthopedic surgeons with pose of this review article is to identify the most common and an alternative to total shoulder arthroplasty (TSA) for the serious complications associated with the RTSA and discuss treatment of rotator cuff tears and arthropathy. Conventional the current methods of management. Complications after TSA relies on the anatomical and functional integrity of the RTSA pose a significant challenge for healthcare providers rotator cuff muscles. This procedure can often be ineffective in and economic burden to society. Therefore, it is essential to patients with massive rotator cuff tears and is associated with make the proper diagnosis and develop and implement early high complication rates [1]. In contrast, RTSA is able to management plans to improve patient outcome and restore functionality for patients with cuff tear arthropathy or satisfaction. in patients with failed conventional total shoulder replacement by virtue of the unique design [1]: the RTSA reverses the shoulder joint by fixing a metal ball to the glenoid and intro- ducing a spherical socket into the proximal end of the humerus [2]. This new construct lowers the humerus and medializes the This article is part of the Topical Collection on Shoulder Surgery: center of rotation to decrease torque at the glenoid component Complications and recruit the deltoid muscle fibers rather than rotator cuff H. S. Zhou : M. D. Price (*) muscles to facilitate arm flexion and drive upper extremity Department of Orthopaedic Surgery, University of Massachusetts function [3]. The ball and socket design with increased contact Medical Center, Worcester, MA, USA surface area provide increased stability or constraint to the e-mail: [email protected] shoulder joint. H. S. Zhou Despite the benefits of the RTSA, patients who undergo e-mail: [email protected] this procedure are often subject to complications that are J. S. Chung : X. Li similar to conventional TSA as well as unique to RTSA Department of Orthopaedic Surgery, Boston University School of because of the major anatomical, physiological, and biome- Medicine, Boston, MA, USA chanical changes to the shoulder joint. The purpose of the present review is to describe the major potential complications P. H. Yi Department of Orthopaedic Surgery, University of California San following RTSA and to provide an overview of management Francisco, San Francisco, CA, USA of such complications. The complications to be covered Curr Rev Musculoskelet Med include infection, nerve injury, intraoperative periprosthetic In a cadaver study, Ladermann et al. [11]demonstratedthat fracture, hematoma, dislocation, scapular notching, acromial after implantation of the reverse shoulder components, the fracture, and complications relating to the glenoid or humeral distance of the axillary nerve was >15 mm from the components. glenosphere; however, the main anterior branch of the axillary nerve was in close contact with the posterior metaphysis or humeral component of the reverse shoulder prosthesis (5.2± 2.1 mm). They theorized that with distalization of the center of Complications rotation, the axillary nerve is lowered and lateralized from the glenosphere component, which protects it from impingement. Nerve injury This altered position places the axillary nerve in close prox- imity to the posterior humeral component and may therefore The most common neurological injuries as a result of RTSA increase the risk of injury. The authors recommended caution procedure involve the brachial plexus or the axillary nerve [4]. when reaming the humeral metaphysis and also avoid retro- This could be attributed to several intraoperative factors: version greater than 20 to 30°. traction, manipulation of the arm, aberrant retractor place- ment, or relative lengthening of the arm [2]. Furthermore, Intraoperative fracture during the glenoid exposure, the humerus is posteriorly retracted, externally rotated, and abducted, resulting in exces- Intraoperative fractures can occur on either the humeral or the sive traction on the brachial plexus and axillary nerve in glenoid side. They are relatively uncommon but can be chal- particular [2]. Electromyography (EMG) should be obtained lenging to manage. Intraoperative humeral fractures mainly after 6 weeks from the onset of symptoms to document the occurred during revision surgeries in the process of removing nerve injury (neuropraxia vs. transection) and should be re- the primary stem or the associated cement mantle. Commonly peated at 6 months to 1 year to follow improvement. used techniques such as avoiding excessive torque and In addition, radial nerve palsy has been reported in the reaming the canal by hand can minimize the chances of literature in RTSA for treatment of failed hemiarthroplasty intraoperative humeral fracture. If the fracture occurred prior for proximal humerus fractures. In this case, the patient had to humeral implantation, then it should be stabilized using subsequent resolution of symptoms with conservative man- cerclage wiring, allograft strut augmentation, or plate and agement [5]. Fortunately, these neurological injuries are rela- screws in addition to a longer stem to bypass the fracture site tively rare and majority of them are reversible within the first [2, 12]. If the fracture occurred after humeral stem implanta- three postoperative months [6]. tion and the implant is stable, then the fracture should be fixed While intraoperative manipulation of the arm certainly can using a combination of cerclage wires or plates and screws lead to nerve palsy, the actual design of the implant itself can [12]. lead to problems as well. Because insufficient deltoid tension Intraoperative glenoid fractures can be a result of the can lead to prosthetic instability, reverse implants are designed reaming process or the fixation technique. Care must be taken to distalize the center of rotation and increase the humeral during the reaming process to ensure the reamer is started on length in order to generate higher deltoid tension and stability, full speed prior to contacting the glenoid and it does not ream which can also put undue stress on the nerves of the upper beyond the subchondral bone so that adequate bone stock may extremity. Van Hoof et al. used a three-dimensional computer be preserved [12]. If intraoperative glenoid fracture does model of a RTSA construct and estimated that the insertion of occur, fragment-specific fixation or redirecting the baseplate prosthesis can lead to 15.3 and 19.3 % increase in strain on the and screws may create a strong fixation for a stable lateral and medial roots of the median nerve, respectively [7]. glenosphere component. In the case of catastrophic glenoid Similarly, Boileau et al. [8] reported 1 case of axillary nerve failure, a two-stage procedure with glenoid bone grafting palsy in a study of 45 consecutive patients who had RTSA (allograft or iliac crest) and reimplantation of the components with the original Grammont (Delta III; Depuy) prosthesis. after bone incorporation into the glenoid. Alternatively, com- Muh et al. [9•] reported 1 case of radial and ulnar nerve palsy plete resection of the glenopshere component and conversion in a series of 67 RTSA procedure using Grammont (Tornier, of the reverse arthroplasty to a large head hemiarthroplasty or France) prosthesis. The patient had incomplete resolution of complete resection arthroplasty may be performed, which will symptoms at 30 months follow-up. Wingert et al. [10]report- result in suboptimal patient outcomes. Boileau et al. [8]re- ed 1 patient with persistent radial, ulnar, and ported 1 case of humeral fracture and 1 case of glenoid
Load more

Recommended publications
  • WARD-DOCUMENT-2020.Pdf (1.324Mb)
    3D Printing Impact on the Orthopedic Shoulder Replacement Global Supply Chain The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Ward, Abner. 2020. 3D Printing Impact on the Orthopedic Shoulder Replacement Global Supply Chain. Master's thesis, Harvard Extension School. Citable link https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365004 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA 3D Printing Impact on the Orthopedic Shoulder Replacement Global Supply Chain Abner M. Ward, MD, MBA, FACS, FAAOS A Thesis in the Field of Biotechnology Management for the Degree of Master of Liberal Arts in Extension Studies Harvard University May 2020 Copyright 2020 [Abner Ward] Abstract The goal of this work was to investigate a novel new technology being used to improve total shoulder replacements in patients with difficult to treat anatomy. The new technology is the use of three-dimensional (3D) implant creations that can be tailored to a patient’s specific shoulder defects as opposed to shelf, standard size implants. The project will help provide management direction to improve the efficiency in the global supply system so that surgeons in various parts of the world may have access to surgical components in the shortest time without significant delay. The study findings were that hindrances to 3D adoption for just-in-time surgical usage primarily include difficulties with sterilization and lack of a global validation metric when performed at multiple international centers, as opposed to one location in a single country.
    [Show full text]
  • Evicore Musculoskeletal Imaging Guidelines
    CLINICAL GUIDELINES Musculoskeletal Imaging Policy Version 2.1 Effective October 1, 2020 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual’s Primary Care Physician (PCP) may provide additional insight. CPT® (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT® five digit codes, nomenclature and other data are copyright 2020 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. © 2020 eviCore healthcare. All rights reserved. Musculoskeletal Imaging Guidelines V2.1 Musculoskeletal Imaging Guidelines Procedure Codes associated with Musculoskeletal Imaging 3 MS-1: General Guidelines 5 MS-2: Imaging Techniques 8 MS-3: 3D Rendering 12 MS-4: Avascular Necrosis (AVN)/Osteonecrosis 13 MS-5: Fractures 16 MS-6: Foreign Body 20 MS-7: Ganglion Cysts 22 MS-8: Gout/Calcium Pyrophosphate Deposition Disease (CPPD)/ Pseudogout/Chondrocalcinosis 24 MS-9: Infection/Osteomyelitis 26 MS-10: Soft Tissue Mass or Lesion of Bone 29 MS-11: Muscle/Tendon Unit
    [Show full text]
  • Clinical Guidelines
    CLINICAL GUIDELINES Joint Services Guidelines Version 1.0.2019 Clinical guidelines for medical necessity review of comprehensive musculoskeletal management services. © 2019 eviCore healthcare. All rights reserved. Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 Large Joint Services CMM-311: Knee Replacement/Arthroplasty 3 CMM-312: Knee Surgery-Arthroscopic and Open Procedures 14 CMM-313: Hip Replacement/Arthroplasty 35 CMM-314: Hip Surgery-Arthroscopic and Open Procedures 46 CMM-315: Shoulder Surgery-Arthroscopic and Open Procedures 47 CMM-318: Shoulder Arthroplasty/ Replacement/ Resurfacing/ Revision/ Arthrodesis 62 ______________________________________________________________________________________________________ © 2019 eviCore healthcare. All Rights Reserved. Page 2 of 69 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-311: Knee Replacement/Arthroplasty CMM-311.1: Definition 4 CMM-311.2: General Guidelines 5 CMM-311.3: Indications and Non-Indications 5 CMM-311.4 Experimental, Investigational, or Unproven 9 CMM-311.5: Procedure (CPT®) Codes 10 CMM-311.6: References 10 ______________________________________________________________________________________________________ © 2019 eviCore healthcare. All Rights Reserved. Page 3 of 69 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-311.1: Definition
    [Show full text]
  • Predictors of Outcome Following Standardized Rehabilitation for Patients with Shoulder Pain
    University of Kentucky UKnowledge Theses and Dissertations--Rehabilitation Sciences Rehabilitation Sciences 2013 Predictors of Outcome Following Standardized Rehabilitation for Patients with Shoulder Pain Stephanie D. Moore University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Moore, Stephanie D., "Predictors of Outcome Following Standardized Rehabilitation for Patients with Shoulder Pain" (2013). Theses and Dissertations--Rehabilitation Sciences. 15. https://uknowledge.uky.edu/rehabsci_etds/15 This Doctoral Dissertation is brought to you for free and open access by the Rehabilitation Sciences at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Rehabilitation Sciences by an authorized administrator of UKnowledge. For more information, please contact [email protected]. STUDENT AGREEMENT: I represent that my thesis or dissertation and abstract are my original work. Proper attribution has been given to all outside sources. I understand that I am solely responsible for obtaining any needed copyright permissions. I have obtained and attached hereto needed written permission statements(s) from the owner(s) of each third-party copyrighted matter to be included in my work, allowing electronic distribution (if such use is not permitted by the fair use doctrine). I hereby grant to The University of Kentucky and its agents the non-exclusive license to archive and make accessible my work in whole or in part in all forms of media, now or hereafter known. I agree that the document mentioned above may be made available immediately for worldwide access unless a preapproved embargo applies.
    [Show full text]
  • Breakthrough in Shoulder Surgery Brings New Hope to Patients
    Breakthrough in Shoulder Surgery Brings New Hope to Patients ll her life, Millie has been active – raising six children, bowling in a league, even skating in After a shoulder replacement, Millie Athe roller derby 60 years ago. But when is back to the job she loves at the 81-year-old from Chantilly began Louise Archer Elementary School. experiencing difficulty raising her arms to complete simple tasks such as brushing her hair or reaching up to a shelf, she knew something was wrong. Her limited range of motion also made it hard to do her office job at Louise Archer Elementary School in Vienna. Millie consulted Commonwealth surgeon David Novak, MD, who diagnosed advanced osteoarthritis in both her shoulders. When several months of cortisone shots failed to alleviate her symptoms, she opted for a total shoulder replacement on her left side. This procedure involves replacing the arthritic joint surfaces with a metal and plastic implant. The components come Dr. Novak is among just a handful of surgeons in the area who in various sizes and are either cemented or press fit into the bone. perform this advanced procedure. “Patients like Millie, with end-stage arthritis and intact rotator cuff tendons, who no longer respond to conservative treatment – such Following both of her surgeries, Millie wore a sling for four weeks. as NSAIDs, cortisone or physical therapy – are generally good She spent two months working with a physical therapist on exercises candidates for total shoulder replacement,” Dr. Novak explains. to regain range of motion and strengthen her shoulder joint. It was all part of a rigorous rehabilitation program that every patient goes The surgery restored function to Millie’s left shoulder and she was through.
    [Show full text]
  • EPO Surgeryplus Plan Amendment
    AMENDMENT TO THE COLORADO EMPLOYER BENEFIT TRUST EPO MEDICAL BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION, EFFECTIVE JANUARY 1, 2019 The CEBT EPO Medical Benefit Plan and Summary Plan Description, effective January 1, 2019 (the “Plan”), shall be amended effective July 1, 2019 to include SurgeryPlus Benefits as follows: 1. Medical Covered Expenses: SURGERYPLUS BENEFIT Charges for certain surgeries, procedures, and related travel expenses are payable as shown on the Schedule of Benefits. This plan will pay charges for surgeries, procedures, and related travel as approved by SurgeryPlus for one Episode of Care. The SurgeryPlus benefit terminates upon your discharge from the hospital, ambulatory surgical center, or other facility following the Episode of Care. Any services rendered after the termination of the Episode of Care are subject to the applicable rules of this plan. Travel benefits may be payable if you do not have access to SurgeryPlus surgeons. The travel benefits will be determined by SurgeryPlus based upon the procedure, provider, and geographic distance of the provider in relation to your residence. Travel benefits may also be provided for a companion if your procedure requires inpatient or overnight care. Travel arrangements must be made through your SurgeryPlus Care Advocate for benefits to be payable. Some examples of the surgeries and procedures available through SurgeryPlus, include, but are not limited to the following: Knee: Foot & Ankle: General Surgery: Knee Replacement Ankle Replacement Gallbladder Removal Knee Replacement
    [Show full text]
  • Understanding Shoulder Pain and Shoulder Replacement Surgery
    Understanding shoulder pain and shoulder replacement surgery. 2 Understanding shoulder pain and shoulder replacement surgery | 1 Table of Contents Understanding how your shoulder works ………………………………… 2 Why does my shoulder hurt? ……………… 3 Proximal Humeral Fracture …………………… 3 Rotator Cuff Arthropathy ……………………… 4 Osteoarthritis …………………………………… 5 Diagnosis ………………………………………… 6 What Is shoulder replacement? ………… 7 What Risks Are Involved? ……………………… 5 What is it Like to have shoulder replacement surgery? ……………………… 9 Understanding shoulder pain and shoulder replacement surgery | 1 Renew your passion for living. If shoulder pain is keeping you from the things you love, you and your doctor may decide it is time for shoulder replacement surgery. While there are many important factors to consider, keep in mind that surgical treatments are designed to reduce pain and restore function. This brochure is intended to provide an overview of shoulder pain and treatment options, and should be reviewed with your orthopedic specialist. It does not include all of the information needed to determine eligibility for shoulder replacement or for the proper use and care of shoulder implant. Please consult your orthopedic specialist for more information. For more information, visit zimmerbiomet.com to find a doctor near you. The information herein is of a general nature and does not represent or constitute medical advice or recommendations and is for general education purposes only. This information is not meant to replace the specific verbal and written recommendations and instructions provided by your surgeon for your specific situation. Patient treatment plans and outcomes will vary. 2 Understanding shoulder pain and shoulder replacement surgery | 3 Understanding how your shoulder works Your shoulder is a ball-and-socket joint made up mainly of two bones.
    [Show full text]
  • Shoulder Replacement Commonly Asked Questions
    Shoulder Replacement Commonly Asked Questions Patrick J Denard, MD Shoulder Specialist 2780 E. Barnett Rd Medford, OR 97530 541-779-6250 Background Information What is the anatomy of the shoulder? The shoulder joint is very complex and involves three bones and more than one joint. These bones are the clavicle (collar bone), the scapula (shoulder blade), and the humerus (upper arm bone). Numerous muscles, ligaments, and tendons surround the joint (Figure). The upper end of the arm bone (humerus) and the outside edge of the scapula bone (glenoid) form a “ball-and-socket joint”. This joint is remarkable because it typically allows greater range of motion than any other joint in your body. WFighuerneis1a shoulder replacement needed? Shoulder replacement surgery is most commonly used for severe degenerative joint disease (osteoarthritis) of the ball-and-socket joint. When the smooth surfaces (cartilage) of the ball and socket become rough, they rub against each other rather than glide. This Updated May 2019 1 rubbing causes pain, stiffness and swelling. Most patients who decide to have shoulder replacement surgery have experienced shoulder pain for a long time. Many patients have developed pain that limits their daily activities, as well as interferes with their sleep. Shoulder stiffness also interferes with the use of their arm for everyday activities. A shoulder replacement is performed to alleviate shoulder pain. It also helps to improve the range of motion of your shoulder joint, which also improves your function and the quality Wofhyaotuarrleifteh. e types of replacement? The two most common types of shoulder replacement are an anatomic shoulder replacement and a reverse total shoulder replacement.
    [Show full text]
  • Arthroscopic Biologic Total Shoulder Replacement the Arthroscopic
    Arthroscopic Biologic Total Shoulder Replacement The arthroscopic biologic total shoulder replacement is a new procedure that I have been working on for more than two years in partnership with my colleagues at Arthrex, Inc. The procedure is designed to resurface, a term used in orthopaedics to commonly refer to ‘replace’, the warn cartilage of the shoulder joint with transplanted donor cartilage and bone. In order to understand the rationale for developing this new procedure, it’s important to consider what is currently done to treat end-stage or late osteoarthritis of the shoulder. The hallmarks of symptomatic osteoarthritis in the shoulder, as with other joints, are pain and stiffness. Patients who have a painful stiff shoulder usually try conservative treatments in the form of oral anti-inflammatories, activity modification, or physical therapy among other modalities. Once conservative measures to relieve pain and/or increase function have failed, which will typically occur over time as part of the natural history of this disorder, operative intervention may be indicated. Typical operative treatments employed for arthritis in the shoulder include arthroscopic debridement with or without chondroplasty and capsular release, partial shoulder replacement, or total shoulder replacement. The outcomes for arthroscopic debridement and chondroplasty as well as other experimental procedures are unpredictable according to several studies reported in the literature. The most reliable operative interventions for the treatment of symptomatic late osteoarthritis have been reported with total shoulder replacement or partial shoulder replacements (hemiarthroplasty). These partial or total shoulder replacements involve removing a substantial part of the ball (proximal humerus) and/or socket (glenoid) bone and replacing the bone with metal and/or plastic.
    [Show full text]
  • BLUEPRINT™ 3D Planning
    MY ARM PATIENT EDUCATION This pamphlet contains general medical information and does not replace the medical advice of your physician. If you have questions about your medical condition or exercises, ask your doctor or health care provider. Talk to your surgeon about whether joint replacement or another treatment is right for you, as well as the recovery time and potential risks of the procedure, including the risk of implant wear, loosening or failure, pain, swelling and ™ infection. Individual results may vary. The performance of joint replacement depends on age, weight, activity level BLUEPRINT and other factors. For complete product information, including indications, contraindications, warnings, precautions and potential adverse effects, visit www.wright.com/shoulder-prescribing-use. 3D Planning + PSI References 1 Joseph Iannotti, MD, PhD, Justin Baker, PhD, Eric Rodriguez, BS, John Brems, MD, Eric Ricchetti, MD, Mena Mesiha, MD, and Json Bryon, MS. Three-dimensional pre-operative planning and a novel information transfer technology improve glenoid component positioning. 2 Hoenecke HR jr1, Hermida JC, Flores-Hernandez C, D’Lima DD. Accuracy of CT based measurements of glenoid version for total shoulder arthroplasty. 3 Gilles Walch, MD, Peter S. Vereridis, MD, Pascal Boileau, MD, Pierric Derasart, M. Eng, Jean Chaoui, PhD. Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study. 4 Hendel, et al. Comparison of Patient-Specific Instrumentation with Standard Surgical Instruments in Determining Glenoid Component Position. JBJS 2014; 96:e71(1-8) 5 Churchill R., Stemless shoulder arthroplasty: current status. J Shoulder Elbow Surg 2014;23:1409-14. 6 Churchill R., Clinical and radiographic outcomes of the SIMPLICITI canal-sparing shoulder arthroplasty system: a prospective two-year multicenter study.
    [Show full text]
  • A Regional Resource for Joint Replacement, Trauma, Orthopedics, Sports Medicine and Spine Problems
    3688 Veterans Memorial Dr. Hattiesburg, MS 39401 appointments, referrals & 2nd opinions: 601-554-7400 Online encyclopedia about orthopedics and spine care at: SouthernBoneandJoint.com A regional resource for joint replacement, trauma, orthopedics, sports medicine and spine problems Decades ago an orthopedic provide patients the most hip and knee replacement. The advanced FDA-approved artificial surgeon would treat all types advanced technology and care technology enables the joint discs that preserve motion in the of joint problems. With ever- specific to their orthopedic injury replacement surgeon to map out spine. increasing new technology and or pain symptom. in advance of surgery the optimal Consquently, these clinical care treatment advances specific to One example is the use of new cuts in the bone for the best centers are referred patients from different joints and bones, that’s Robotic Surgery Technology. The surgical outcome and to spare as across the region. changed dramatically. Over hip and knee surgeons make use much bone as possible. Appointments, referrals and the past 15 years, orthopedics of Mako Robotic Surgery that Similarly, the spine surgeons in second opinions can be set up by has become super-specialized improves the outcomes from The Spine Center provide the most calling 601-554-7400. with surgeons now becoming fellowship-trained in a specific body part, such as foot/ankle or ORTHOPEDIC SPECIALTY CENTERS LOCATIONS hand/arm or spine. The best care comes from a specialized approach. Consequently, MAIN CLINIC LOCATION: Because of this super 3688 Veterans Memorial Drive Southern Bone and Joint Specialists is organized into CLINICAL CARE specialization in orthopedics, Hattiesburg, MS 39401 CENTERS that provides the most advanced treatment options.
    [Show full text]
  • Spinal Surgery Coding Pain Coding
    Spinal Surgery coding Pain Coding CASE STUDIES, DISCUSSION ROBIN INGALLS-FITZGERALD, CCS, CPC, FCS, CEDC, CEMC CEO/PRESIDENT MEDICAL MANAGEMENT AND REIMBURSEMENT SPECIALISTS, LLC Agenda Discuss spinal procedures CPT PCS And more Spinal Fusions- PCS coding Some of the most complex surgeries to code in ICD-10 Spinal fusion is classified by the anatomic portion (column) fused and the technique (approach) used to perform the fusion. The fusion can include a discectomy, bone grafting, and spinal instrumentation. Spinal Fusions Anterior Column: The body (corpus) of adjacent vertebrae (interbody fusion). The anterior column can be fused using an anterior, lateral, or posterior technique. Posterior Column: Posterior structures of adjacent vertebrae (pedicle, lamina, facet, transverse process, or “gutter” fusion). A posterior column fusion can be performed using a posterior, posterolateral, or lateral transverse technique. Approaches: Posterior or from the back (most common); anterior through a laparotomy Spinal Anatomy Devices Interbody fusion devices —e.g. BAK cages, PEEK cages, bone dowels Autologous Tissue Substitute —bone graft obtained from the patient during the procedure. Bone grafts may be harvested locally using the same incision, or from another part of the body requiring a separate incision. Harvesting requires a separate procedure code ONLY when it is performed through a separate incision. Nonautologous Tissue Substitute —bone bank Synthetic Substitute —examples include demineralized bone matrix, synthetic bone graft extenders, bone morphogenetic proteins (BMP) Interbody Fusion Devices The interbody fusion device immobilizes the intervertebral joint to stabilize the segment for fusion. It restores disc space height and requires removal of all or part of the disc so that the device can be inserted into the disc space.
    [Show full text]