CPT® Code 24362

1. Indications

The procedure described by CPT® Code 24362 is indicated for patients with significant elbow joint dysfunction due to various conditions. These may include:

• Severe Osteoarthritis - A degenerative joint disease causing pain and stiffness in the elbow.
• Rheumatoid Arthritis - An autoimmune condition leading to inflammation and damage of the elbow joint.
• Post-Traumatic Arthritis - Arthritis that develops after an injury to the elbow joint.
• Elbow Fractures - Complex fractures that may not heal properly, leading to joint instability.
• Joint Deformities - Abnormalities in the elbow joint that affect function and range of motion.

2. Procedure

The procedure for CPT® Code 24362 involves several detailed steps to ensure successful elbow arthroplasty with ligament reconstruction:

• Step 1: Incision and Exposure - A skin incision is made over the elbow joint, either medial or lateral to the olecranon process. This allows access to the joint for the surgical procedure.
• Step 2: Soft Tissue Dissection - The surgeon dissects the soft tissues and identifies the ulnar nerve, which is carefully protected throughout the procedure to prevent nerve damage.
• Step 3: Lateral Epicondyle Exposure - The lateral epicondyle of the humerus is exposed by incising the interval between the anconeus and flexor carpi ulnaris muscles, followed by mobilizing the triceps muscle.
• Step 4: Elbow Joint Preparation - The anconeus muscle is elevated off the lateral aspect of the proximal ulna, and the radial aspect of the elbow joint is addressed by dissecting tissue off the lateral epicondyle.
• Step 5: Joint Capsule Removal - The elbow is externally rotated and flexed, allowing for the removal of the posterior joint capsule and exposure of the olecranon roof.
• Step 6: Ligament Release - The medial collateral ligament is released from the epicondyle, facilitating further access to the joint.
• Step 7: Humeral Preparation - Tissue is dissected off the humerus, and the roof of the olecranon fossa is removed down to the level of cancellous bone, preparing the site for the implant.
• Step 8: Canal Reaming - The humeral canal is reamed to accommodate the prosthetic implant.
• Step 9: Implant Placement - A cutting guide is used to remove the distal aspect of the humerus along the plane of the medial and lateral supracondylar columns. A trial implant is placed to check for proper width and alignment before the permanent humeral implant is inserted.
• Step 10: Cementing the Implant - Bone cement is injected in a retrograde fashion to secure the permanent humeral implant in place.
• Step 11: Ligament Reconstruction - Ligaments and tendons are reattached, and a fascia lata graft may be harvested for ligament reconstruction, enhancing joint stability.
• Step 12: Ulnar Nerve Management - The triceps muscle is medialized, and a subcutaneous pocket is created for the ulnar nerve, which is then placed between subcutaneous fat and fascia near the medial epicondyle.
• Step 13: Closure - The fascia and skin are closed in layers, ensuring proper healing.
• Step 14: Postoperative Positioning - The arm is fully extended and placed in a splint to support the joint during the initial recovery phase.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. Postoperative care may include pain management, physical therapy to restore range of motion, and instructions on how to care for the surgical site. The use of a splint helps to immobilize the elbow, allowing for proper healing. Patients are advised to follow up with their healthcare provider to assess the recovery progress and to ensure that the implant and reconstructed ligaments are functioning as intended. Rehabilitation exercises may be introduced gradually to enhance recovery and restore strength and mobility in the elbow joint.