Hi Everyone
I have never coded this surgery before please help.
Preoperative Diagnosis: Advanced osteoarthritis, left knee.
Postoperative Diagnosis: Advanced osteoarthritis, left knee.
Operation: Cemented left total knee replacement using Zimmer Persona
ultracongruent component.
Description of Procedures: The patient was brought to the operating room after satisfactory
induction of spinal anesthesia; tourniquet was placed around the upper portion of the left thigh. The
left leg was prepped and draped in the usual sterile manner. The surgical time-out was done per
protocol. The leg was exsanguinated with an Esmarch bandage and the tourniquet inflated to 300
mmHg. A standard anterior incision was made followed by a median parapatellar approach to the
knee. The soft tissues were released from around the medial aspect of the tibia and both the anterior
and posterior cruciate ligaments were resected from the notch. An intramedullary alignment guide was
used to direct the distal femoral cut at 6 degrees of valgus, was taken off due to the disparity between
the medial and lateral femoral condyles in this projection. Distal femoral cut was made. Retractors
were positioned around the proximal tibia. An external referencing guide was used to direct the
proximal tibial cut. The minimal 2 mm was taken off of the very most worn posterolateral portion of the
lateral tibial plateau. The extension gap was checked. It appeared the knee would take a 10 mm
polyethylene.
Attention was returned to the distal femur. It sized to a size 5. Rotation was adjusted using the
posterior referencing guide at 3 degrees of external rotation, it was cross-referenced with Whitesides
line, which it matched and the epicondylar axis. The size 5, cutting block was attached and the distal
cut on the femur were made. The proximal tibia sized to a size E. Rotation was adjusted, so the
middle portion was along the medial 1/3 of the patellar tendon. The proximal tibia was then reamed
and broached to accept a size E tibial component. The patella tracked well. A lateral release was not
needed. The patella was not resurfaced, but the peripheral osteophytes from around the edges were
removed. The trial components were removed. The bony surfaces were prepared with the pulsating
lavage. One batch of high viscosity cement with antibiotic was mixed at the appropriate consistency.
The tibia was cemented, followed by the femoral component. Extraneous cement was removed from
around the edges and the trial 10 mm polyethylene was put onto the tibial tray. The leg was brought
into full extension to allow the cement to harden. While the cement was hardening, the bone surfaces
were not covered by implant, were covered by bone wax. The cement required just over 13 minutes
to harden, after which the tourniquet was released. Tourniquet time was under 50 minutes. No
unusual bleeding was encountered. The posterior aspect of the knee was carefully inspected to make
certain that there were no remnants of debris, bone cement, etc. The final deep irrigation and
inspection was carried out and then the real 10 mm ultracongruent polyethylene was put onto the
tibial tray. The deep tissues were closed with interrupted figure-of-eight #1 Vicryl. The subcutaneous
tissues were closed with 2-0 Vicryl & skin was closed with skin staples. Bulky dressing was applied.
I have never coded this surgery before please help.
Preoperative Diagnosis: Advanced osteoarthritis, left knee.
Postoperative Diagnosis: Advanced osteoarthritis, left knee.
Operation: Cemented left total knee replacement using Zimmer Persona
ultracongruent component.
Description of Procedures: The patient was brought to the operating room after satisfactory
induction of spinal anesthesia; tourniquet was placed around the upper portion of the left thigh. The
left leg was prepped and draped in the usual sterile manner. The surgical time-out was done per
protocol. The leg was exsanguinated with an Esmarch bandage and the tourniquet inflated to 300
mmHg. A standard anterior incision was made followed by a median parapatellar approach to the
knee. The soft tissues were released from around the medial aspect of the tibia and both the anterior
and posterior cruciate ligaments were resected from the notch. An intramedullary alignment guide was
used to direct the distal femoral cut at 6 degrees of valgus, was taken off due to the disparity between
the medial and lateral femoral condyles in this projection. Distal femoral cut was made. Retractors
were positioned around the proximal tibia. An external referencing guide was used to direct the
proximal tibial cut. The minimal 2 mm was taken off of the very most worn posterolateral portion of the
lateral tibial plateau. The extension gap was checked. It appeared the knee would take a 10 mm
polyethylene.
Attention was returned to the distal femur. It sized to a size 5. Rotation was adjusted using the
posterior referencing guide at 3 degrees of external rotation, it was cross-referenced with Whitesides
line, which it matched and the epicondylar axis. The size 5, cutting block was attached and the distal
cut on the femur were made. The proximal tibia sized to a size E. Rotation was adjusted, so the
middle portion was along the medial 1/3 of the patellar tendon. The proximal tibia was then reamed
and broached to accept a size E tibial component. The patella tracked well. A lateral release was not
needed. The patella was not resurfaced, but the peripheral osteophytes from around the edges were
removed. The trial components were removed. The bony surfaces were prepared with the pulsating
lavage. One batch of high viscosity cement with antibiotic was mixed at the appropriate consistency.
The tibia was cemented, followed by the femoral component. Extraneous cement was removed from
around the edges and the trial 10 mm polyethylene was put onto the tibial tray. The leg was brought
into full extension to allow the cement to harden. While the cement was hardening, the bone surfaces
were not covered by implant, were covered by bone wax. The cement required just over 13 minutes
to harden, after which the tourniquet was released. Tourniquet time was under 50 minutes. No
unusual bleeding was encountered. The posterior aspect of the knee was carefully inspected to make
certain that there were no remnants of debris, bone cement, etc. The final deep irrigation and
inspection was carried out and then the real 10 mm ultracongruent polyethylene was put onto the
tibial tray. The deep tissues were closed with interrupted figure-of-eight #1 Vicryl. The subcutaneous
tissues were closed with 2-0 Vicryl & skin was closed with skin staples. Bulky dressing was applied.