Has anyone encountered an arthroscopic removal of glenoid component? I am looking towards CPT 29819 removal of loose or foreign body, however I do not see any mention of a lager cannula used. I do see where he mentions a posterior and anterior portal were made. I am thinking CPT 23334 is only for an open procedure. Any imput is greatly appreciated! Thank you.
POSTOPERATIVE DIAGNOSIS: Painful right total shoulder arthroplasty with confirmed glenoid component loosening.
PROCEDURE PERFORMED: 1. Right Shoulder arthroscopic removal of glenoid component
DESCRIPTION OF PROCEDURE: The patient was identified and marked in the preoperative area. His H&P and consent form were signed and updated. He had a regional block placed by anesthesia service without complication. He was taken to the operating room where he was intubated and sedated. He was placed in the lateral decubitus position. His right arm was placed in a traction tower. His right upper extremity was prepped and draped in a normal sterile fashion. Preoperative antibiotics were given.After a surgical time-out was performed, we started with a posterior portal and then made an anterior portal under direct visualization. He had a lot of inflammatory synovitis in the shoulder. We inserted a probe, and I felt that his glenoid component was loose. With simple probing, anterior and posterior, it appeared that it was rocking, I thought that this was consistent with our preoperative diagnosis of subtle instability of the glenoid component. We looked at the rotator cuff. The supraspinatus and infraspinatus were intact. Anteriorly, the subscapularis appeared to be intact. We could see some of the sutures from the underside of the previous repair, but I did not detect any large fullthickness tears with retraction of the tendon. His rotator interval was pretty scarred in place.From here, we elected to do arthroscopic removal of the glenoid component. I first started with some arthroscopic biters to see if we could make any progress with that, but that was very slow. We switched and used the bur, and this made much more significant progress. We were able to work through about two thirds or so of the poly before, I felt like the bur was wearing down, and we switched out to a new bur, which helped to speed up our progress. We actually were able to get a large posterior fragment of it through the cannula. With this came out one of the peripheral pegs, one of the superior peripheral pegs was also easily removed and then the anteroinferior peripheral pegs was one that we were able to pry out of the glenoid and then removed that. The central peg was the one that was more difficult. It was spinning so rotationally not completely stable; however, it was not easy to remove. We used several different instruments and removed the superficial part of it down until we got to the first ring of the expanded flanges. I thought that this was actually stable and so did not need to be fully removed, so we removed any inflamed synovium around it and debrided the edges back to stable base. Final arthroscopic images were obtained. We took care to make sure that there were no metallic fragments, only found one of those we had to remove, there was little bit of plastic debris up by the cannula, but after removed the cannula and inserted the shaver back, we removed all of these to our satisfaction.From here, we moved down to closure. We thoroughly irrigated with saline solution. We closed portal sites with nylon suture. Sterile dressings were applied. The patient was awakened from anesthesia and taken to the recovery area in stable condition.
POSTOPERATIVE DIAGNOSIS: Painful right total shoulder arthroplasty with confirmed glenoid component loosening.
PROCEDURE PERFORMED: 1. Right Shoulder arthroscopic removal of glenoid component
DESCRIPTION OF PROCEDURE: The patient was identified and marked in the preoperative area. His H&P and consent form were signed and updated. He had a regional block placed by anesthesia service without complication. He was taken to the operating room where he was intubated and sedated. He was placed in the lateral decubitus position. His right arm was placed in a traction tower. His right upper extremity was prepped and draped in a normal sterile fashion. Preoperative antibiotics were given.After a surgical time-out was performed, we started with a posterior portal and then made an anterior portal under direct visualization. He had a lot of inflammatory synovitis in the shoulder. We inserted a probe, and I felt that his glenoid component was loose. With simple probing, anterior and posterior, it appeared that it was rocking, I thought that this was consistent with our preoperative diagnosis of subtle instability of the glenoid component. We looked at the rotator cuff. The supraspinatus and infraspinatus were intact. Anteriorly, the subscapularis appeared to be intact. We could see some of the sutures from the underside of the previous repair, but I did not detect any large fullthickness tears with retraction of the tendon. His rotator interval was pretty scarred in place.From here, we elected to do arthroscopic removal of the glenoid component. I first started with some arthroscopic biters to see if we could make any progress with that, but that was very slow. We switched and used the bur, and this made much more significant progress. We were able to work through about two thirds or so of the poly before, I felt like the bur was wearing down, and we switched out to a new bur, which helped to speed up our progress. We actually were able to get a large posterior fragment of it through the cannula. With this came out one of the peripheral pegs, one of the superior peripheral pegs was also easily removed and then the anteroinferior peripheral pegs was one that we were able to pry out of the glenoid and then removed that. The central peg was the one that was more difficult. It was spinning so rotationally not completely stable; however, it was not easy to remove. We used several different instruments and removed the superficial part of it down until we got to the first ring of the expanded flanges. I thought that this was actually stable and so did not need to be fully removed, so we removed any inflamed synovium around it and debrided the edges back to stable base. Final arthroscopic images were obtained. We took care to make sure that there were no metallic fragments, only found one of those we had to remove, there was little bit of plastic debris up by the cannula, but after removed the cannula and inserted the shaver back, we removed all of these to our satisfaction.From here, we moved down to closure. We thoroughly irrigated with saline solution. We closed portal sites with nylon suture. Sterile dressings were applied. The patient was awakened from anesthesia and taken to the recovery area in stable condition.