27358 Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (List in addition to code for primary procedure)

Name of the Procedure:

Excision or Curettage of Bone Cyst or Benign Tumor of the Femur with Internal Fixation

Summary

This surgical procedure involves the removal (excision) or scraping (curettage) of a non-cancerous cyst or tumor from the femur (thigh bone). Internal fixation techniques are then used to stabilize the bone, typically involving screws, plates, or rods.

Purpose

The procedure addresses the presence of benign bone cysts or tumors within the femur. The primary goals are to remove abnormal growths, alleviate pain, prevent fractures, and restore normal bone function.

Indications

• Persistent pain in the thigh or knee.
• A swelling or lump felt in the thigh.
• A fracture that occurs with minimal or no trauma (pathological fracture).
• Imaging studies showing a bone cyst or benign tumor.
• Lack of response to conservative treatments like medication or physical therapy.

Preparation

• Patients may be instructed to fast for 6-8 hours before surgery.
• Discontinuation of certain medications, such as blood thinners, may be required.
• Pre-operative imaging studies like X-rays or MRIs.
• Blood tests to ensure the patient is fit for surgery.
• Discussion of anesthesia options with the anesthesiologist.

Procedure Description

1. Anesthesia is administered, often general.
2. Incision: A surgical cut is made over the affected area of the femur.
3. Excision/Curettage: The surgeon removes or scrapes away the bone cyst or tumor.
4. Internal Fixation: The bone is stabilized using metal plates, screws, or rods.
5. Closure: The incision is closed with sutures or staples.
6. Dressing: A sterile bandage is applied to the wound site.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic Surgeon: Performs the procedure.
• Anesthesiologist: Manages anesthesia.
• Surgical Nurses: Assist in the operating room.
• Radiologic Technologist: May assist with intraoperative imaging.

Risks and Complications

• Common Risks: Infection, bleeding, and blood clots.
• Rare Risks: Damage to surrounding tissues, nerve injury, and reaction to anesthesia.
• Management: Antibiotics for infection, pain management protocols, and close post-operative monitoring.

Benefits

• Relief from pain.
• Prevention of fractures.
• Improved mobility and function.
• Long-term stabilization of the femur.

Recovery

• Post-procedure Care: Monitoring in a recovery room, pain management, and instructions on wound care.
• Recovery Time: Generally, a few weeks to a few months, depending on individual healing rates.
• Restrictions: Limited weight-bearing on the affected leg, use of crutches or walkers, and gradual return to normal activities.
• Follow-up: Regular appointments for X-rays and assessments by the orthopedic surgeon.

Alternatives

• Observation: Monitoring small, asymptomatic cysts or tumors.
• Non-surgical management: Includes medications, physical therapy, or needle aspiration.

## Pros and Cons of Alternatives:

• Observation: Non-invasive but does not address symptomatic or growing cysts/tumors.
• Non-surgical Management: Less invasive but may not be effective for large or symptomatic lesions.

Patient Experience

• During Procedure: Patients under general anesthesia will be asleep and feel no pain.
• Post-procedure: Soreness and pain managed by prescribed medications. Physical discomfort typically decreases over time, with activities being gradually resumed based on medical advice. Pain management and comfort measures like ice, elevation, and rest are essential.