CPT® Code 24155

1. Indications

The procedure of elbow resection (arthrectomy) is indicated for several specific conditions that affect the elbow joint. These include:

• Joint immobility due to trauma, which may result from fractures or dislocations that compromise the joint's function.
• Infection within the joint, which can lead to significant inflammation and damage to the joint structures.
• Other disease processes that may cause degeneration or destruction of the joint, such as rheumatoid arthritis or osteoarthritis.
• Failure of total elbow replacement, where previously implanted prosthetic components have not functioned as intended, necessitating further surgical intervention.

2. Procedure

The elbow resection procedure involves several critical steps to ensure effective removal of the damaged joint components. The following outlines the procedural steps:

• Step 1: The surgical site is prepared, and the patient is positioned appropriately to allow access to the elbow joint. An incision is made based on the selected approach, which may be posterior, posterolateral, medial, or anterolateral, depending on the specific joint damage.
• Step 2: For a posterolateral approach, a proximal incision is made starting from the lateral supracondylar ridge, extending to the lateral epicondyle, and curving distally to the posterior border of the ulna. This incision allows for adequate exposure of the joint.
• Step 3: The anterior musculature is carefully stripped away to expose the anterior capsule of the elbow joint. Key muscles such as the extensor carpi radialis longus (ECRL) are retracted and elevated off the lateral epicondyle to facilitate access.
• Step 4: The ECRL, along with the brachioradialis and brachialis muscles, is elevated off the joint capsule to provide a clear view of the joint structures. The lateral collateral ligament (LCL) and ulnar nerve are identified and protected throughout the procedure.
• Step 5: The common extensor tendon is dissected off the LCL and joint capsule, allowing for further access to the joint. The joint capsule is then incised, and the internal joint structures are examined for damage.
• Step 6: An oscillating saw is utilized to excise the olecranon process, which exposes the articular surface of the posterior humerus. This step is crucial for removing the deteriorated joint surfaces.
• Step 7: The damaged joint surfaces from both the humerus and radius are excised as necessary, ensuring that all compromised areas are addressed. All bone edges are smoothed to promote healing.
• Step 8: After the resection, muscles and tendons are reattached to the remaining bony surfaces to restore stability and function to the elbow joint.
• Step 9: A drain may be placed to prevent fluid accumulation, and the joint capsule is closed. Finally, the surgical wound is repaired in layers, and appropriate dressings are applied to complete the procedure.

3. Post-Procedure

Post-procedure care following an elbow resection involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients may be advised on pain management strategies and may require physical therapy to regain mobility and strength in the elbow joint. The recovery process can vary based on the extent of the resection and the individual patient's condition, but close follow-up with the surgical team is essential to assess healing and functional recovery.