Arthroplasty, interposition, intercarpal or carpometacarpal joints
CPT4 code
Name of the Procedure:
Arthroplasty, Interposition, Intercarpal or Carpometacarpal Joints
Common Names: Wrist Joint Replacement, Thumb Joint Replacement
Summary
The procedure, Arthroplasty, interposition for intercarpal or carpometacarpal joints, involves surgically replacing or reconstructing the wrist or thumb joints. This surgery aims to alleviate pain and restore function by placing materials between the bones to cushion the joint.
Purpose
Medical Condition: Osteoarthritis, rheumatoid arthritis, traumatic injury, or other degenerative joint diseases affecting the wrist or thumb joints.
Goals: Reduce pain, improve joint function, and enhance the quality of life.
Indications
Symptoms/Conditions: Severe pain, reduced mobility, joint deformity, and loss of hand function.
Patient Criteria: Patients who have not responded to conservative treatments (e.g., medications, physical therapy) and have significant joint damage affecting daily activities.
Preparation
Instructions: Patients may need to fast for 8 hours before surgery and might need to stop certain medications (e.g., blood thinners).
Assessments: Preoperative evaluation including physical examination, blood tests, and imaging studies (e.g., X-rays, MRI).
Procedure Description
- Anesthesia: Typically performed under general anesthesia or regional anesthesia (nerve block).
- Incision: A small incision is made over the affected joint.
- Joint Preparation: Damaged joint surfaces are removed.
- Interposition: Placement of soft tissue or synthetic materials between the bones to act as a spacer or cushion.
- Closing: The incision is closed with sutures or staples, followed by dressing and immobilization.
Tools/Equipment: Surgical instruments, synthetic spacers (if used), sutures/staples.
Technology: Imaging guidance may be used for accurate placement.
Duration
Typically takes 1 to 2 hours, but can vary based on complexity.
Setting
Performed in a hospital operating room or an outpatient surgical center.
Personnel
Healthcare Professionals: Orthopedic surgeon, anesthesiologist, surgical nurses, and sometimes a hand therapist for post-operative care.
Risks and Complications
Common Risks: Infection, blood clots, joint stiffness, and pain.
Rare Risks: Nerve damage, implant failure, prolonged swelling, or allergic reaction to materials.
Management: Most complications can be managed with medications, physical therapy, or additional surgical intervention as needed.
Benefits
Expected Benefits: Significant pain relief, improved joint function, and enhanced quality of life.
Realization: Benefits may be noticeable within a few weeks to months post-surgery.
Recovery
Post-Procedure Care: Immobilization with a splint or cast, keeping the limb elevated, and taking prescribed pain medications.
Recovery Time: Typically, 6 to 12 weeks, with physical therapy starting a few weeks after surgery.
Restrictions: Avoid heavy lifting and strenuous activities during the recovery period. Follow-up appointments are crucial to monitor healing.
Alternatives
Other Treatment Options: Non-surgical options include physical therapy, medications, corticosteroid injections, or joint fusion.
Pros and Cons: Non-surgical treatments have fewer risks but may not provide long-term relief. Joint fusion offers stability but limits motion.
Patient Experience
During the Procedure: Patients are under anesthesia, so they will not feel pain during surgery.
After the Procedure: Post-operative pain is managed with medications. Patients might experience discomfort, swelling, and limited mobility for the first few days. Rehabilitation will include exercises to regain strength and flexibility, with ongoing pain management strategies.