CPT® Code 27286

1. Indications

The procedure of hip joint arthrodesis with subtrochanteric osteotomy is indicated for specific conditions and patient scenarios, including:

• Young Patients This procedure is often considered for younger individuals who are heavy laborers and may not be suitable candidates for hip replacement due to their activity level and the demands placed on the hip joint.
• Failed Hip Replacement Patients who have experienced complications or failures following a hip replacement may require this procedure as a salvage operation to alleviate pain and restore function.

2. Procedure

The surgical procedure for hip joint arthrodesis with subtrochanteric osteotomy involves several critical steps:

• Lateral Incision A lateral incision is made over the hip joint to provide access to the femoral head. This incision allows the surgeon to dislocate the femoral head from the acetabulum, which is necessary for the subsequent steps of the procedure.
• Debridement of Articular Surfaces Once the femoral head is dislocated, the articular surfaces of both the femoral head and acetabulum are thoroughly debrided down to the bleeding cancellous bone. This step is crucial as it prepares the surfaces for optimal fusion.
• Harvesting Cancellous Bone An incision is made over the iliac crest, where the overlying bone is incised to access cancellous bone. This harvested bone is essential for packing into the joint space to promote fusion.
• Bone Grafting The harvested cancellous bone is prepared and packed into the joint space between the femoral head and acetabulum. This grafting material aids in the fusion process.
• Repositioning the Femoral Head After packing the joint space with bone graft, the femoral head is returned to its position within the acetabulum.
• Stabilization with Internal Fixation A plate and screw device is applied along the femur and pelvis to hold the hip joint stationary. This stabilization is critical to ensure that the bones heal together properly.
• Subtrochanteric Osteotomy Following the arthrodesis, the planned osteotomy sites are marked, and a series of cuts are made in the subtrochanteric region of the femur. Bone is excised, and wedges created from the cut bone are strategically placed at the osteotomy sites to maintain proper angles.
• Morcellization and Additional Grafting Some of the excised cancellous bone may be morcellized and used for additional bone grafting as needed to enhance the fusion process.
• Internal Fixation for Osteotomy Internal fixation devices, such as pins, screws, or wires, are utilized as necessary to maintain the shape and position of the bone during the healing phase.

3. Post-Procedure

Post-procedure care for patients undergoing hip joint arthrodesis with subtrochanteric osteotomy typically involves monitoring for signs of healing and potential complications. Patients may require a period of immobilization to ensure proper stabilization of the hip joint. Rehabilitation and physical therapy are often initiated to restore mobility and strength as healing progresses. The expected recovery time can vary based on individual patient factors, but the goal is to achieve a successful fusion of the femoral head and acetabulum, ultimately alleviating pain and improving function.