# Exchange of All Polythylene Components - Knee



## Sara82 (Mar 9, 2011)

Does anyone have any knowledge of what code to use for just the exchange of the Polythylene for all the components? 27487 -27486 ? Considering all the extra work performed, would I still use a 52 modifier or is there another code that would work better? Any help is gretly appriciated - Thank you!

OPERATION PERFORMED:
1.  Arthrotomy of right total knee with removal of all
polyethylene mobile bearing components.
2.  Extensive resection of arthrofibrosis, right knee joint, all
compartments, anterior, medial, lateral, and posterior.
3.  Replacement of tibial rotating platform poly RP bearing,
replacement of patellar polyethylene bearing.


We slowly released all soft tissues to identify and analyze the
contractures.  There was roughly 1.5 inches of very dense
arthrofibrotic scar tissue encasing the entire knee.  The poly
portion of the patellar component was removed and the poly at the
tibial aspect removed without difficulty.  A cutting technique
was used to remove the rotating platform bearing.  This gave us
less tension on the soft tissue envelope.  All lap tapes was
inserted between the femoral and tibial components to prevent
scratching.  We slowly and meticulously worked our way around the
entire joint cavity, starting at the 12 o'clock position,
removing all of arthrofibrotic tissue with a Bovie cautery.  This
included the posterior compartment as well.  We inspected the
devices.  They were well fixed, secured.  Patellar component,
well fixed and secured.

We continued with placement of a trial poly, #10 as we had been
previously.  I was able to achieve full extension and confirmed
this once again by measurement as we did during the index total
knee replacement procedure.  We replaced the old poly of the
patella and placed 2-0 Vicryl sutures through the fascia to
simulate a closed reduction and closure of the arthrotomy.  I
then cycled the knee through a range of motion and was very
easily able to achieve 0 to 105 degrees specifically with a great
improvement in flexion.  The mobile bearing was stable.  There
was no excess instability pattern had developed.  The trial poly
was removed at all aspects and the cavity inspected and flushed
with antibiotic saline.  We inspected for extraneous point
bleeders.  There was expected soft tissue oozing, considering a
tourniquet was not being utilized.  A new final tibial poly was
placed with subluxation of the knee without disruption of the
appropriate ligament structures.  A new polyethylene patellar
component was snapped into position and secured.  A medium
Hemovac drain was placed.


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