Sara82
Guru
Im pretty sure Ive read that the synovectomy and debridement would be included in the revision. Im just not sure how I would code the revision - I was thinking maybe 27486-52 ? Below is a brief outline of the Op Report. Any other suggestions?
OPERATION PERFORMED:
Left knee open complete synovectomy with an irrigation and
debridement of an infected total knee with a revision of the
tibial polyethylene component and patellar polyethylene
component.
A midline
incision was made over the patient's prior scar. I made a medial
arthrotomy, and upon making a medial arthrotomy, there was
purulent fluid which basically exploded out of the knee. I took
new cultures once again as it was interesting that as we went
distal, the medial soft tissue was not healed to the proximal
medial tibia, or it had undermined with the infection and then
the infection looked like it almost went under the patellar
tendon, most of the tendon was intact certainly, but I actually
placed a bone staple into the tibial tubercle, just to protect it
because of the revision, I did not want it to avulse and then I
would take it off at the end. I made a medial parapatellar
arthrotomy. I was extremely careful of the neurovascular
structures throughout the case. I initially performed a complete
synovectomy going all over the entire knee just very carefully
and meticulously using curettes and rongeurs as well as the Bovie
removing the inflamed synovium. I was very careful posteriorly.
I removed the patellar polyethylene, and I literally used a soft
brush to just try to scrub any potential glycocalyx from the
prosthesis, but being careful not to scratch it of course. I
then removed the polyethylene from the tibia, and then was able
to do the same thing on both the femoral and tibial prostheses as
well as posteriorly. I was very careful posteriorly of course.
I used multiple liters of antibiotic-impregnated irrigation
fluid to pulse lavage the knee throughout the entire case. Once
everything was very clean, we changed all the gloves. We changed
the suction tip. I then placed a new 12.5 tibial polyethylene
which was the same size that was removed, and this was double
checked, and the same on the patella polyethylene. The revision
of the patellar polyethylene and tibial polyethylene component
was made, but the metal itself was left alone because it was well
fixed. The staple in the patellar tendon was removed. The
patellar tendon was well fixed. It was just a little bit of
undermining medially which looked like it was just due to the
infection was unusual. 2 drains were placed laterally, and the
tourniquet was let down. Hemostasis was meticulously achieved.
OPERATION PERFORMED:
Left knee open complete synovectomy with an irrigation and
debridement of an infected total knee with a revision of the
tibial polyethylene component and patellar polyethylene
component.
A midline
incision was made over the patient's prior scar. I made a medial
arthrotomy, and upon making a medial arthrotomy, there was
purulent fluid which basically exploded out of the knee. I took
new cultures once again as it was interesting that as we went
distal, the medial soft tissue was not healed to the proximal
medial tibia, or it had undermined with the infection and then
the infection looked like it almost went under the patellar
tendon, most of the tendon was intact certainly, but I actually
placed a bone staple into the tibial tubercle, just to protect it
because of the revision, I did not want it to avulse and then I
would take it off at the end. I made a medial parapatellar
arthrotomy. I was extremely careful of the neurovascular
structures throughout the case. I initially performed a complete
synovectomy going all over the entire knee just very carefully
and meticulously using curettes and rongeurs as well as the Bovie
removing the inflamed synovium. I was very careful posteriorly.
I removed the patellar polyethylene, and I literally used a soft
brush to just try to scrub any potential glycocalyx from the
prosthesis, but being careful not to scratch it of course. I
then removed the polyethylene from the tibia, and then was able
to do the same thing on both the femoral and tibial prostheses as
well as posteriorly. I was very careful posteriorly of course.
I used multiple liters of antibiotic-impregnated irrigation
fluid to pulse lavage the knee throughout the entire case. Once
everything was very clean, we changed all the gloves. We changed
the suction tip. I then placed a new 12.5 tibial polyethylene
which was the same size that was removed, and this was double
checked, and the same on the patella polyethylene. The revision
of the patellar polyethylene and tibial polyethylene component
was made, but the metal itself was left alone because it was well
fixed. The staple in the patellar tendon was removed. The
patellar tendon was well fixed. It was just a little bit of
undermining medially which looked like it was just due to the
infection was unusual. 2 drains were placed laterally, and the
tourniquet was let down. Hemostasis was meticulously achieved.
