Brandi
New
Can I get opinions on how to code this surgery? The plan was to revise the glenoid component but he took it out and didn't replace it. He converted the total shoulder to a hemi.
Thanks!
PREOPERATIVE DIAGNOSES:
1. Right total shoulder loose glenoid component.
2. Painful right total shoulder replacement.
POSTOPERATIVE DIAGNOSES:
1. Right total shoulder loose glenoid component.
2. Painful right total shoulder replacement.
PROCEDURES:
1. Right shoulder revision, total shoulder replacement.
2. Right shoulder removal of the glenoid component.
INDICATIONS:
She is a 57-year-old woman who is several years out from a right total
shoulder replacement. She has had pain recently which has failed to
improve with all conservative measures. She had a recent arthroscopy of
her shoulder, which I documented that her glenoid component was loose and
with macro motion possible, it was felt that a revision of this procedure
was indicated to relieve her pain.
DETAILS OF PROCEDURE:
Informed consent was obtained. She was taken to the operating room. She
was given interscalene as well as general anesthesia. We placed her in
the beach chair position with her right arm prepped and draped free.
Preoperative antibiotics were given, and a proper timeout was taken. We
made an incision in line with her old scar. I dissected down through the
soft tissue to get down very carefully to the deltopectoral interval,
which I exposed. There was a fair amount of scar tissue present about I
was able to get it exposed very carefully. The subscapularis was
identified and was opened to expose the joint. There was some joint fluid
but no evidence of purulence. We then carefully placed retractors to
expose the proximal humeral component. We removed the head using an
osteotome. The stem was clearly very well fixed with no motion possible.
We did take deep cultures. There was some filmy tissue around the
proximal humerus, which I removed with the curette and rongeur. We then
exposed the glenoid carefully. There was extensive inflammatory tissue
present in the glenoid cavity. We removed this with a rongeur and
curette. The glenoid appeared to have loosened and migrated inferiorly.
We then carefully removed it with an osteotome without difficulty as it
was grossly loose. We then exposed the glenoid cavity carefully. There
was fair amount of bone loss in the central cavity from loose component
and the central cavity had lost curvature. I did not feel that there will
be enough bone stock to adequately hold a cemented glenoid component to
match the humeral side. We explored this and exposed it carefully, but I
did not find a really good option to retain the glenoid component.
Therefore, we decided to not place a new glenoid component as there was no
good bone stalk to accommodate it. We therefore felt that we can convert
her to a hemiarthroplasty. We then exposed the humeral side once again.
We got very good adequate exposure and noted the rotator cuff was clearly
intact and still well inserted. We then replaced the humeral side with a
similar 44 mm head with a new component as old one had been damaged from
removal. We placed a new 44 mm head and got secure fixation and good
coverage of humeral surface. We then reduced the shoulder and found very
good stability and good range of motion. We repaired the subscapularis
back through his previous tenotomy and the rotator cuff was completely
explored and found to be intact. We irrigated the wound very thoroughly
and obtained hemostasis and then closed the soft tissue and skin in
layers. We applied sterile dressings and a sling, and she was awakened
and taken to the recovery room in good condition.
Thanks!
PREOPERATIVE DIAGNOSES:
1. Right total shoulder loose glenoid component.
2. Painful right total shoulder replacement.
POSTOPERATIVE DIAGNOSES:
1. Right total shoulder loose glenoid component.
2. Painful right total shoulder replacement.
PROCEDURES:
1. Right shoulder revision, total shoulder replacement.
2. Right shoulder removal of the glenoid component.
INDICATIONS:
She is a 57-year-old woman who is several years out from a right total
shoulder replacement. She has had pain recently which has failed to
improve with all conservative measures. She had a recent arthroscopy of
her shoulder, which I documented that her glenoid component was loose and
with macro motion possible, it was felt that a revision of this procedure
was indicated to relieve her pain.
DETAILS OF PROCEDURE:
Informed consent was obtained. She was taken to the operating room. She
was given interscalene as well as general anesthesia. We placed her in
the beach chair position with her right arm prepped and draped free.
Preoperative antibiotics were given, and a proper timeout was taken. We
made an incision in line with her old scar. I dissected down through the
soft tissue to get down very carefully to the deltopectoral interval,
which I exposed. There was a fair amount of scar tissue present about I
was able to get it exposed very carefully. The subscapularis was
identified and was opened to expose the joint. There was some joint fluid
but no evidence of purulence. We then carefully placed retractors to
expose the proximal humeral component. We removed the head using an
osteotome. The stem was clearly very well fixed with no motion possible.
We did take deep cultures. There was some filmy tissue around the
proximal humerus, which I removed with the curette and rongeur. We then
exposed the glenoid carefully. There was extensive inflammatory tissue
present in the glenoid cavity. We removed this with a rongeur and
curette. The glenoid appeared to have loosened and migrated inferiorly.
We then carefully removed it with an osteotome without difficulty as it
was grossly loose. We then exposed the glenoid cavity carefully. There
was fair amount of bone loss in the central cavity from loose component
and the central cavity had lost curvature. I did not feel that there will
be enough bone stock to adequately hold a cemented glenoid component to
match the humeral side. We explored this and exposed it carefully, but I
did not find a really good option to retain the glenoid component.
Therefore, we decided to not place a new glenoid component as there was no
good bone stalk to accommodate it. We therefore felt that we can convert
her to a hemiarthroplasty. We then exposed the humeral side once again.
We got very good adequate exposure and noted the rotator cuff was clearly
intact and still well inserted. We then replaced the humeral side with a
similar 44 mm head with a new component as old one had been damaged from
removal. We placed a new 44 mm head and got secure fixation and good
coverage of humeral surface. We then reduced the shoulder and found very
good stability and good range of motion. We repaired the subscapularis
back through his previous tenotomy and the rotator cuff was completely
explored and found to be intact. We irrigated the wound very thoroughly
and obtained hemostasis and then closed the soft tissue and skin in
layers. We applied sterile dressings and a sling, and she was awakened
and taken to the recovery room in good condition.