CPT® Code 27177

1. Indications

The open treatment of slipped femoral epiphysis (SCFE) using CPT® Code 27177 is indicated for the following conditions:

• Slipped Capital Femoral Epiphysis A condition where the growth plate slips from its normal position, leading to hip pain and potential complications if not treated.
• Severe Slippage Cases where the degree of slippage is significant enough to warrant surgical intervention to restore proper alignment and function of the hip joint.
• Failure of Conservative Treatment Situations where non-surgical management has not been effective in alleviating symptoms or stabilizing the condition.

2. Procedure

The procedure for the open treatment of slipped femoral epiphysis involves several critical steps:

• Incision and Exposure A lateral skin incision is made over the hip joint to provide access to the femur. The surrounding soft tissues are carefully dissected to expose the femur adequately.
• Evaluation of Slippage Once the femur is exposed, the surgeon evaluates the degree of slippage of the femoral head. This assessment is crucial for determining the appropriate repair technique.
• Guidewire Placement If pinning is chosen as the repair method, the surgeon determines the pin site(s) and angle(s) for insertion. A guidewire is then placed into the bone at the first insertion site, advanced using gentle tapping or drilling.
• Confirmation of Guidewire Position The correct position of the guidewire is confirmed through radiographic imaging to ensure accurate placement before proceeding.
• Pin or Screw Insertion After confirming the guidewire's position, it is removed, and a pin or screw is inserted into the tract created by the guidewire. This step is repeated for additional pins or screws as necessary, with each placement confirmed radiographically.
• Bone Graft Harvesting (if required) If a bone graft is needed, the surgeon exposes the bone harvest site by dividing and stripping away the overlying muscle tissue. Common sites for harvesting include the iliac crest, tibia, fibula, and greater trochanter of the femur. Cortical and/or cancellous bone may be harvested as needed.
• Preparation of Bone Graft The harvested bone is prepared for placement into the defect in the capital femoral epiphysis. This may involve crushing cancellous bone or reshaping cortical bone to fit the required size and shape.
• Placement of Bone Graft The prepared bone graft is then placed into the defect to support the healing process.
• Closure of Incisions Finally, the incisions at both the harvest site and over the femur are closed in layers, with entry incisions secured using sutures to ensure proper healing.

3. Post-Procedure

Post-procedure care following the open treatment of slipped femoral epiphysis includes monitoring for complications, managing pain, and ensuring proper healing of the surgical site. Patients may require physical therapy to regain strength and mobility in the hip joint. Follow-up appointments are essential to assess the alignment of the femoral head and the success of the pinning or grafting procedure. The expected recovery time may vary based on the severity of the condition and the individual patient's response to surgery.