CPT® Code 27156

1. Indications

The procedure is indicated for the following conditions:

• Congenital Malformation A condition where the iliac, acetabular, or innominate bones are abnormally formed, leading to functional impairments.
• Leg Length Discrepancy A significant difference in the length of the legs, which can result from malformations of the pelvic or femoral bones.
• Subluxation of the Hip A partial dislocation of the hip joint, which may occur due to improper alignment of the femoral head and acetabulum.
• Dislocation of the Hip A complete dislocation of the hip joint, necessitating surgical intervention to restore proper alignment and function.

2. Procedure

The surgical procedure involves several critical steps to ensure successful correction of the malformations:

• Step 1: Evaluation and Exposure The surgeon begins by carefully evaluating the specific nature of the congenital malformation affecting the iliac, acetabular, or innominate bones, as well as the femur. Once the evaluation is complete, the affected bones are surgically exposed to allow for direct access during the osteotomy.
• Step 2: Marking and Cutting The planned osteotomy sites on the pelvic bone are marked to guide the surgical cuts. The surgeon then makes precise cuts in the bone at these marked sites, allowing for the reconfiguration of the bone shape to correct the malformation.
• Step 3: Femoral Assessment and Osteotomy Following the pelvic osteotomy, the femur is assessed for any malformations. Cuts are made in the femur to facilitate necessary adjustments, which may include shortening, lengthening, or reshaping the bone to achieve proper alignment with the pelvis.
• Step 4: Reduction of the Femoral Head If the femoral head is found to be malpositioned, the surgeon performs a reduction to reposition it correctly. The pelvic osteotomy is then performed around the newly reduced femoral head, ensuring that the reshaped pelvic bones conform appropriately.
• Step 5: Wedge Placement and Fixation Wedges created from the cut bone are strategically placed at the osteotomy sites to maintain the proper angles and alignment of the bones. Internal fixation devices, such as pins, screws, or wires, are utilized as needed to secure the bones in their new positions and ensure stability during the healing process.

3. Post-Procedure

After the procedure, patients typically require a period of recovery that may involve pain management and physical therapy to restore mobility and function. The surgical site will need to be monitored for signs of infection or complications. Follow-up appointments are essential to assess the healing process and ensure that the bones are properly aligned and stable. The duration of recovery can vary based on the individual patient's condition and the extent of the surgery performed.