CPT® Code 27151

1. Indications

The osteotomy of the iliac, acetabular, or innominate bone with femoral osteotomy is performed for specific indications, primarily related to structural abnormalities of the hip and femur. The following conditions may warrant this surgical intervention:

• Congenital Malformations - Conditions present at birth that affect the shape and structure of the iliac, acetabular, or innominate bones, leading to functional impairments.
• Leg Length Discrepancy - A significant difference in the length of the legs, which can result from malformations in the pelvic or femoral bones.
• Subluxation of the Hip - A partial dislocation of the hip joint, where the femoral head is not properly seated in the acetabulum, often requiring surgical correction.
• Dislocation of the Hip - A complete dislocation of the hip joint that may necessitate realignment and stabilization through surgical intervention.

2. Procedure

The procedure for performing an osteotomy of the iliac, acetabular, or innominate bone with femoral osteotomy involves several critical steps, each designed to ensure the successful correction of the identified malformations:

• Step 1: Evaluation and Planning - The surgical team conducts a thorough evaluation of the patient's condition, including imaging studies to assess the extent of the malformations in the pelvic and femoral bones. This assessment guides the surgical planning process.
• Step 2: Exposure of the Bones - The surgeon makes an incision to expose the iliac, acetabular, or innominate bones and the femur. This step is crucial for accessing the areas that require osteotomy.
• Step 3: Marking the Osteotomy Sites - The planned sites for the osteotomies on the pelvic bone are carefully marked. This ensures precision in the subsequent cuts that will be made to reshape the bone.
• Step 4: Performing the Osteotomy - Cuts are made in the pelvic bone at the marked sites to allow for reconfiguration. The surgeon may also evaluate the femur for any malformations and perform necessary cuts to adjust its length or shape.
• Step 5: Reducing the Femoral Head - If the femoral head is malpositioned, it is reduced to its proper location. The pelvic osteotomy is then performed around the newly positioned femoral head to ensure proper alignment.
• Step 6: Placement of Bone Wedges - Wedges created from the cut bone are strategically placed at the osteotomy sites. This helps maintain the correct angles and alignment of the reshaped bones.
• Step 7: Internal Fixation - The surgeon uses internal fixation devices, such as pins, screws, or wires, to secure the bones in their new positions, ensuring stability during the healing process.

3. Post-Procedure

After the completion of the osteotomy procedure, the patient will require careful monitoring and post-operative care. This may include pain management, physical therapy, and follow-up appointments to assess healing and alignment. The expected recovery period can vary based on the extent of the surgery and the individual patient's condition. Patients are typically advised on weight-bearing restrictions and rehabilitation exercises to promote optimal recovery and restore function to the hip and leg.