Arthroplasty with prosthetic replacement; lunate
CPT4 code
Name of the Procedure:
Arthroplasty with Prosthetic Replacement; Lunate Commonly known as: Lunate Replacement Surgery, Lunate Arthroplasty
Summary
Arthroplasty with prosthetic replacement for the lunate involves surgically removing the damaged lunate bone in the wrist and replacing it with an artificial prosthesis. This procedure aims to restore wrist function and alleviate pain caused by diseases like Kienböck's disease.
Purpose
Medical Condition: This procedure addresses conditions such as Kienböck's disease, arthritis, or severe trauma that has damaged the lunate bone. Goals/Outcomes: The main objectives are to reduce pain, improve wrist mobility, and enhance the overall function of the wrist.
Indications
Symptoms/Conditions: Chronic wrist pain, loss of motion, and grip strength, swelling, and instability in the wrist. Patient Criteria: Typically recommended for patients who have not responded to conservative treatments like medication, splinting, or physical therapy.
Preparation
Instructions: Patients are usually instructed to fast for at least 8 hours prior to the procedure and may need to stop certain medications, such as blood thinners, under physician guidance. Assessments: Pre-operative assessments include wrist X-rays, MRI, and blood tests to evaluate the overall health and specific wrist pathology.
Procedure Description
- Anesthesia: The patient is given regional anesthesia, sometimes combined with sedation, or general anesthesia based on the case specifics.
- Incision: A surgical incision is made over the wrist.
- Bone Removal: The damaged lunate bone is carefully removed.
- Prosthesis Placement: The artificial lunate prosthesis is positioned and secured in place.
- Closure: The incision is closed using sutures or staples, and the wrist is bandaged.
Tools/Equipment: Surgical scalpel, saw, prosthetic lunate, sutures, and possible fluoroscopy for imaging guidance.
Duration
The procedure typically takes about 2 to 3 hours.
Setting
This surgery is commonly performed in a hospital or a specialized surgical center with appropriate facilities.
Personnel
- Surgeon: An orthopedic or hand surgeon.
- Anesthesiologist: To manage anesthesia.
- Nurses: Operating room and recovery room nurses.
- Surgical Assistants: To aid the surgeon during the procedure.
Risks and Complications
Common Risks: Infection, bleeding, swelling, pain. Rare Risks: Prosthesis dislocation, allergic reactions to materials, nerve damage, impaired wrist function. Complication Management: Complications are managed through medications, additional surgery, or physical therapy based on severity.
Benefits
Patients can expect significant pain relief and improvement in wrist function. Benefits often become evident within months of recovery.
Recovery
Post-procedure Care: Patients may need to wear a splint or cast and keep the wrist elevated. Pain management includes medications. Recovery Time: Full recovery may take several months, with physical therapy often required. Restrictions: Avoid heavy lifting and wrist-straining activities. Regular follow-ups with the surgeon are necessary.
Alternatives
Other Treatments: Conservative treatments (meds, splinting), wrist fusion, partial carpal fusion. Pros/Cons: Alternative therapies vary in invasiveness, recovery time, and effectiveness. Arthroplasty offers a balance between pain relief and functional restoration compared to wrist fusion.
Patient Experience
During surgery, the patient will be under anesthesia and should not feel pain. Post-surgery, there may be discomfort, manageable with prescribed pain medications. The patient may feel stiffness initially, and gradual improvement with physical therapy.
Pain management typically includes medication, and measures like ice packs and elevation are used to reduce swelling and enhance comfort.