CPT® Code 27181

1. Indications

The open treatment of slipped femoral epiphysis using CPT® Code 27181 is indicated for the following conditions:

• Slipped Capital Femoral Epiphysis (SCFE) - This condition is characterized by the backward displacement of the femoral head due to slippage at the growth plate, which can lead to hip pain and limited mobility.
• Severe Slippage - Indicated when there is significant displacement of the femoral head that requires surgical intervention to restore proper alignment and function.
• Failure of Conservative Treatment - When non-surgical management, such as rest or physical therapy, has not alleviated symptoms or improved the condition.

2. Procedure

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

• Step 1: Incision and Exposure - A lateral skin incision is made over the hip joint to provide access. The surrounding soft tissues are carefully dissected to expose the hip joint adequately.
• Step 2: Joint Capsule Incision - The joint capsule is incised to allow for direct visualization and evaluation of the femoral head and neck. This step is crucial for assessing the degree of slippage.
• Step 3: Evaluation of Slippage - The surgeon evaluates the extent of the slippage to determine the appropriate surgical technique for correction. This assessment is vital for planning the subsequent steps of the procedure.
• Step 4: Bone Wedge Excision - A wedge of bone is excised from either the distal aspect of the femoral neck or the proximal aspect of the femoral head. This excision compensates for the backward slippage and facilitates realignment.
• Step 5: Realignment - The femoral head, neck, and shaft are repositioned to their correct anatomical alignment. This step is essential for restoring normal hip function.
• Step 6: Internal Fixation - The repositioned structures are secured using internal fixation devices, such as pins or screws, to maintain stability during the healing process.

3. Post-Procedure

After the procedure, patients typically require monitoring for any complications and may need to follow a rehabilitation program to regain strength and mobility in the hip joint. Pain management and physical therapy are often part of the post-operative care plan. The expected recovery time can vary based on the individual’s overall health and adherence to rehabilitation protocols. Regular follow-up appointments are essential to assess healing and ensure proper alignment of the femoral head and neck.