CPT® Code 27443

1. Indications

The procedure is indicated for patients suffering from degenerative joint disease that has led to significant knee pain and dysfunction. The following conditions may warrant the performance of this arthroplasty:

• Degenerative Joint Disease - A condition characterized by the breakdown of cartilage and underlying bone in the knee, leading to pain and limited mobility.
• Bone Spurs - Bony projections that develop along the edges of bones, often causing pain and restricting movement.
• Inflamed Synovium - Swelling of the synovial membrane, which can contribute to joint pain and stiffness.

2. Procedure

The procedure involves several critical steps to ensure successful arthroplasty of the femoral condyles or tibial plateaus:

• Step 1: Incision and Joint Inspection - An anterior incision is made over the knee joint, allowing access to the joint capsule. The capsule is incised to inspect the joint for damage and assess the extent of the degenerative changes.
• Step 2: Exposure of the Distal Femur - If the arthroplasty is to be performed on the femoral condyles, the distal femur is exposed. A cutting guide is placed on the end of the femur to ensure that the bone cut is made accurately, maintaining proper alignment of the joint and leg angles.
• Step 3: Bone Cutting and Prosthesis Placement - Bone is cut from the distal end of the femur. A prosthetic femoral component is then placed on the femur. Depending on the type of prosthesis, it may be secured using either friction (for uncemented prostheses) or bone cement (for cemented prostheses).
• Step 4: Preparation of the Proximal Tibia - If the procedure involves the tibial plateaus, the proximal tibial surface is prepared using alignment rods to ensure proper joint and bone alignment. Any contracted knee ligaments due to degenerative changes are released to facilitate the procedure.
• Step 5: Trial Component and Range of Motion Evaluation - A trial component is placed to evaluate the range of motion of the knee joint, ensuring that the alignment and fit are appropriate before finalizing the prosthetic placement.
• Step 6: Tibial Component Placement - The tibial component, consisting of a metal tray and spacer, is then placed on the tibia. The metal tray is secured to the bone using bone cement or screws, followed by the attachment of the spacer to the tray.
• Step 7: Final Checks and Closure - The range of motion is checked again to ensure proper function. Finally, the overlying soft tissues and skin are repaired in layers to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring proper recovery. Patients may experience swelling and discomfort, which can be managed with pain relief medications. Rehabilitation typically begins shortly after surgery, focusing on restoring range of motion and strengthening the knee. Physical therapy is often recommended to aid in recovery and improve functional outcomes. Follow-up appointments are essential to assess the healing process and the performance of the prosthetic components.