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• 00.74, Hip bearing surface, metal-on-polyethylene;

Hemiarthroplasty (unipolar and bipolar) of the hip is a commonly performed procedure for the treatment of displaced intraarticular fractures of the neck of the femur in the elderly. The goal of treatment of displaced fractures of the neck of the femur is to return the patients to their pre-injury mobility status as early as possible and to minimize the risk of further operation. Austin Moore and Thompson prostheses have fulfilled these criteria for decades but have been associated with a poor quality of life in the long term with a very high incidence of groin and thigh pain in physically active elderly patients, largely a consequence of acetabular cartilage degeneration and stem loosening respectively.,, In our study group of failed hemiarthroplasty 41% patients complained of groin pain, 25% of thigh pain and 14% had both. Bipolar arthroplasty was introduced to improve the long-term outcome of hemiarthroplasty as a result of less wear of the metal-cartilage interface by providing another interface (metal-polyethylene) inside the bipolar head. However, recent studies comparing bipolar to unipolar hemiarthroplasty show little difference between the two with regard to morbidity, mortality, or functional outcome.

• 00.73, Revision of hip replacement, acetabular liner and/or femoral head only; and

One of the investigators evaluated the postoperative radiographs obtained at one month postoperatively. The parameters recorded were cup abduction angle and alignment of the stem. Stem alignment was measured as the angle between the femoral stem and the long axis of the femur on anteroposterior radiographs and was classified as varus, neutral or valgus. On the lateral radiograph, the stem alignment was classified as anterior, neutral or posterior. Limb-length discrepancy was also recorded by measuring the distance of the upper margin of the lesser trochanter from the inter-teardrop line. Follow-up radiographs were evaluated for stem subsidence, appearance/progression of radiolucent lines, osteolysis, stress-shielding of proximal femur, loosening and bony ingrowth according to the criteria described by Engh et al.

• 00.75, Hip bearing surface, metal-on-metal;

• 00.76, Hip bearing surface, ceramic-on-ceramic; and

The indication for surgery in the majority of the patients was groin pain (18 patients); thigh pain was present in 11, six patients had both groin and thigh pain, and nine patients had loss of function and were unable to walk. A preoperative diagnosis of acetabular erosion and protrusio was made in 14 hips (32%), aseptic femoral loosening in 15 (34%), septic loosening in six (12%), prosthesis breakage in four (9%), dislocation in three (7%), and periprosthetic fracture in two hips (5%) []. Preoperative HHS was 38 (range 15-62). An average shortening of 2.4 cm (range 0-4cm) was recorded preoperatively. Eight patients had an elevated ESR, CRP was found to be elevated in seven patients. Majority of the patients, 24 out of 44, were community ambulators (with support in all but one) but needed regular analgesics; 11 patients were homebound, and nine were bedridden.

Out of seven patients with presumptive diagnosis of infection one patient was suitable for same stage implantation, five patients were treated with a two-stage revision and one patient needed a three-stage revision. Additional procedures that were done included release of iliopsoas in 24 patients; extended trochanteric osteotomy in five patients to facilitate removal of the femoral implants (broken implant in four and a well-fixed intact prosthesis in one) [].

• 00.77, Hip bearing surface, ceramic-on-polyethylene.

• synthetic substitute, metal;

Malkani JBJS Br 1995
- 33 hips 11 years
- poor function (50% severe limp or unable to walk)
- 64% 12 years survival
- 22% dislocation

- desired stem cemented into allograft
- press fit distally into host femur
- step cut graft host junction
- secure cerclage wire and onlay cortical strut
- proximal host bone wrapped around allograft with ABD preservation

• synthetic substitute, metal on polyethylene;
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• synthetic substitute, ceramic;

Coding and sequencing for hip replacement surgery depend on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

• synthetic substitute, ceramic on polyethylene; and

For the qualifier (character 7), the choices include cemented, uncemented, or no qualifier. For example, a left total hip arthroplasty using a cemented stem and a metal-on-plastic articulating surface is classified to code 0SRB029.

Fracture which extends between the trochanters of the proximal femur

- use in all cases
- good with elderly fragile bone
- can use Abx cement (decreases infection rate)

- lower limit is inferior border of lesser tuberosity

- press fit metaphyseal segment
- slotted diaphyseal segment
- initial stability through distal fixation

Extra capsular / well vascularized

- use in all cases
- good with elderly fragile bone
- can use Abx cement (decreases infection rate)

The key to stability is the posteromedial cortex

- morcellised bone graft is osteoconductive, not osteoinduction
- resorption and eventual replacement new bone
- 6 – 12 months
- process is incomplete

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