CPT® Code 27178

1. Indications

The procedure described by CPT® Code 27178 is indicated for the treatment of a slipped capital femoral epiphysis (SCFE) in adolescents. The following conditions may warrant this surgical intervention:

• Slipped Capital Femoral Epiphysis (SCFE) - A condition where the growth plate slips from its normal position, leading to hip pain and potential complications if not addressed.
• Severe Slippage - Cases where the degree of slippage is significant enough to require surgical correction to restore proper alignment and function of the hip joint.
• Failure of Conservative Treatment - Instances where non-surgical management, such as rest or physical therapy, has not resulted in improvement of symptoms or alignment.

2. Procedure

The procedure for CPT® Code 27178 involves several critical steps to ensure the successful treatment of SCFE through closed manipulation and pinning:

• Radiographic Evaluation - Initial radiographs are obtained to assess the extent of slippage of the femoral head. This imaging is essential for planning the surgical approach and determining the degree of manipulation required.
• Manual Manipulation - The surgeon manually manipulates the femoral head and neck back into anatomical alignment. This step is crucial for restoring the proper position of the femoral head within the acetabulum.
• Pin Placement - Once the femoral head is aligned, pins are placed to maintain this alignment. The placement of these pins is performed using an open technique, which involves making an incision to access the hip joint and ensure accurate positioning.
• Confirmation of Position - After the pins are inserted, their position is confirmed radiographically to ensure that they are correctly placed and providing the necessary stabilization to the femoral head.
• Closure of Incisions - Following the successful placement of pins and confirmation of their position, the incisions made during the procedure are closed in layers. This includes suturing the entry incisions to promote proper healing.

3. Post-Procedure

After the procedure, patients typically require monitoring for any complications and to assess the effectiveness of the treatment. Post-operative care may include pain management, physical therapy, and follow-up radiographs to evaluate the alignment of the femoral head and the integrity of the pin placement. Patients are usually advised on activity restrictions to allow for proper healing and to prevent further injury. The expected recovery time can vary based on the individual case and the extent of the procedure performed.