CPT® Code 27440

1. Indications

The procedure of arthroplasty of the tibial plateau is indicated for patients suffering from degenerative joint disease, which may manifest through various symptoms and conditions. The following are explicitly provided indications for this surgical intervention:

• Degenerative Joint Disease - This condition leads to the deterioration of the articular surfaces of the knee, causing pain and functional impairment.
• Osteoarthritis - A common form of arthritis characterized by the breakdown of cartilage in the knee joint, resulting in pain and stiffness.
• Severe Knee Pain - Patients experiencing significant pain that limits daily activities may be candidates for this procedure.
• Reduced Range of Motion - A noticeable decrease in the ability to move the knee joint freely can indicate the need for surgical intervention.
• Joint Instability - Conditions that lead to instability in the knee joint may necessitate arthroplasty to restore function and stability.

2. Procedure

The arthroplasty procedure for the tibial plateau involves several critical steps to ensure successful outcomes. The following procedural steps are outlined:

• Step 1: Incision - An incision is made over the anteromedial or anterolateral aspect of the knee, depending on which tibial plateau is affected. This approach allows the surgeon to access the joint capsule effectively.
• Step 2: Joint Capsule Inspection - The joint capsule is incised, and the medial and/or lateral compartment of the knee is inspected to assess the extent of damage and prepare for the procedure.
• Step 3: Proximal Tibial Surface Preparation - The proximal tibial surface is prepared using either intramedullary or extramedullary alignment rods. This step is crucial for ensuring proper alignment of the joint and bone angles during the placement of the prosthetic components.
• Step 4: Ligament Release - If degenerative joint disease has caused the knee ligaments to become contracted, they are released to restore normal function and range of motion.
• Step 5: Trial Component Placement - A trial component is placed to evaluate the range of motion and ensure proper fit before the final prosthetic components are secured.
• Step 6: Tibial Component Placement - The tibial component, which consists of a metal tray and spacer, is then placed on the tibia. The metal tray is secured to the bone using either bone cement or screws.
• Step 7: Spacer Attachment - The spacer is attached to the metal tray, completing the assembly of the prosthetic component.
• Step 8: Range of Motion Check - The range of motion is checked to ensure that the knee functions properly with the new components in place.
• Step 9: Soft Tissue and Skin Repair - Finally, the overlying soft tissues and skin are repaired in layers to promote healing and restore the integrity of the knee.

3. Post-Procedure

After the arthroplasty procedure, patients can expect a recovery period that may involve pain management, physical therapy, and follow-up appointments to monitor healing. Post-operative care typically includes instructions on weight-bearing activities, exercises to improve range of motion, and precautions to prevent complications. The expected recovery time may vary based on individual health factors and the extent of the surgery, but patients are generally encouraged to engage in rehabilitation to regain strength and mobility in the knee joint.