Arthroplasty with prosthetic replacement; distal ulna
CPT4 code
Name of the Procedure:
Arthroplasty with prosthetic replacement; distal ulna
Common Names: Ulnar Head Replacement, Distal Ulnar Arthroplasty
Summary
Arthroplasty with prosthetic replacement of the distal ulna is a surgical procedure to replace the damaged end of the ulna bone in the wrist with an artificial prosthesis. This helps restore the function and mobility of the wrist and forearm.
Purpose
Medical Condition Addressed:
- Severe arthritis
- Traumatic injury
- Instability or deformity of the distal ulna
Goals and Expected Outcomes:
- Pain relief
- Improved wrist motion
- Enhanced grip strength
- Restoration of normal arm function
Indications
Symptoms and Conditions:
- Chronic wrist pain unresponsive to conservative treatments
- Severe osteoarthritis or rheumatoid arthritis affecting the distal ulna
- Recurrent dislocations or subluxations of the distal ulna
- Previous trauma leading to distal ulna damage
Patient Criteria:
- Poor response to non-surgical treatments like medications, physical therapy, or splinting
- Presence of joint deformity or functional impairment
- Good overall health to withstand surgery
Preparation
Pre-Procedure Instructions:
- Fasting for at least 8 hours prior to surgery
- Adjustments to medications (e.g., stopping blood thinners)
- Arrange for transportation and post-surgery assistance at home
Diagnostic Tests:
- X-rays or MRI to assess the extent of bone damage
- Blood tests to check overall health and readiness for surgery
Procedure Description
- Anesthesia: General anesthesia or regional anesthesia (nerve block) is administered.
- Incision: A surgical incision is made over the wrist to expose the distal ulna.
- Bone Preparation: The damaged portion of the distal ulna is carefully removed.
- Prosthetic Placement: A prosthetic implant is inserted into the place of the removed bone.
- Closure: The incision is closed with sutures, and the area is bandaged.
Tools and Equipment:
- Surgical instruments for bone removal
- Prosthetic implant specific to distal ulna
Duration
The procedure typically takes about 1-2 hours.
Setting
Performed in a hospital or specialized outpatient surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Pain at the surgery site
Rare Risks:
- Prosthesis loosening or failure
- Nerve damage
- Blood clots
Complications Management:
- Antibiotics for infections
- Pain management strategies
- Monitoring for nerve function and blood flow
Benefits
Expected Benefits:
- Pain relief usually noticed within weeks post-surgery
- Improved function and mobility of the wrist and hand
- Long-term durability of the prosthetic implant
Recovery
Post-Procedure Care:
- Elevation of the arm to reduce swelling
- Pain medications as prescribed
- Physical therapy to restore strength and mobility
Expected Recovery Time:
- Generally, 6-12 weeks for complete recovery
- Temporary restrictions on heavy lifting or strenuous activities
Follow-Up:
- Regular check-ups to monitor healing and prosthetic function
Alternatives
Other Treatment Options:
- Non-surgical options like medications, physical therapy, or braces
- Wrist fusion surgery
- Interpositional arthroplasty (using biological material instead of a prosthesis)
Pros and Cons:
- Non-surgical options may not provide long-term relief.
- Wrist fusion results in loss of wrist motion but provides stability and pain relief.
- Interpositional arthroplasty can be complex and may not be suitable for all patients.
Patient Experience
During the Procedure:
- Under anesthesia, the patient will not feel pain or be aware of the procedure.
After the Procedure:
- Some pain and swelling managed by medications and ice packs
- Physical therapy to aid in recovery and regain function
- Motivation and adherence to rehabilitation are crucial for optimal outcomes