# Arthroscopic curettage and bone grafting of subchondral acetabular cyst help



## Richard Sigler (Oct 9, 2013)

My surgeon preformed this surgery and I need some coding help for it. 

POSTOPERATIVE DIAGNOSIS:  Right hip acetabular subchondral cyst.

PROCEDURE:  Right hip arthroscopy, curettage and bone grafting of
subchondral acetabular cyst

DESCRIPTION OF PROCEDURE:  The patient was first identified and the
operative limb was marked.  She was then brought to the operating room
table where she was positioned supine on the standard table and general
anesthesia was induced.  She was then placed on the specialized traction
table and the legs were placed into padded traction boots around a
rather well thickly padded peroneal post.  Both legs were placed into
gentle in-line traction and abduction and the right leg was then placed
into further longitudinal traction, as well as internal rotation and
adduction.  The C-arm was brought in to confirm adequate distraction
could be achieved at the hip joint.  The hip was then prepped and draped
in the usual sterile manner.  A spinal needle was then used to enter the
hip joint through the location of the anterolateral portal.  C-arm
guidance was used for this step as the needle punctured the hip capsule
and entered the hip joint.  The hip was then insufflated with
approximately 30 mL of sterile saline improving the distraction of the
hip joint and the traction on the leg was released.  A guidewire was
then used to exchange the needle for tissue dilators and was replaced
through a small stab incision in the skin.  An arthroscopic cannula was
then placed and a 70-degree arthroscope was introduced.

Immediately I could see an area of cartilage blister on the anterior
portion of the acetabulum.  A spinal needle was then introduced using an
outside-in technique in the location of the off right anterior portal.
A stab incision was then made in this location and the guidewire was
used to exchange this for tissue dilators and an arthroscopic ***.
There was quite a bit of synovitis in the anterior portion of the hip,
but this was resected using a motorized shaver.  An anterior portal
capsulotomy was then performed with a Beaver blade.  The scope was then
switched into the anterior portal and the capsulotomy was further
extended to the anterolateral portal and slightly posterior from there.
A thorough examination of the hip joint revealed this blistered area of
the acetabular cartilage and a small 1 cm location on the anterior
portion of the acetabulum.  There was no obvious labral tear.  There was
a normal posterior labral sulcus that was intact to articular cartilage
throughout the remainder of the acetabulum and intact to the femoral
head articular cartilage.  An elevator was then used to elevate the
labrum in the location of the acetabular blister.  This was in the area
consistent with an acetabular cyst evident on the MRI.  Curets were then
introduced into the cyst beneath the articular cartilage and they were
used to debride the cyst.  Calcific-appearing contents were retrieved
and sent to pathology.

Bleeding was then noted at the location of the cyst and I was able to do
this without disrupting the intact overlying articular cartilage.  A
Jamshidi needle was then used to introduce approximately 0.5 mL of
demineralized bone matrix cadaveric allograft.  The anterior acetabular
rim was treated with a burr to just decorticate the surface slightly and
improve healing.  The labrum, which had been elevated to access the
acetabular cyst, was then repaired using 2 Mitek Gryphon absorbable
suture anchors in the anterior acetabular rim.  The final repair was
very stable.  The hip was reduced.  The bone graft remained within the
cyst.  The hip was taken through a full range of motion and there was
found to be no obvious impingement into the zone of the labrum.  The
wounds were irrigated copiously with normal saline, the skin was closed
with 4-0 nylon interrupted sutures and a sterile dressing was placed.

Any help with this surgery will be much appriciated.


----------



## nyyankees (Oct 10, 2013)

Richard Sigler said:


> My surgeon preformed this surgery and I need some coding help for it.
> 
> POSTOPERATIVE DIAGNOSIS:  Right hip acetabular subchondral cyst.
> 
> ...



What I see was 29863 (Synovectomy) and you could capture the cyst debridement/removal with the unlisted 29999. I think the carrier will bundle it but you could appeal and see what happens. The labral repair (29916) would be part of the closure and not reportable.


----------

