Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening
CPT4 code
Name of the Procedure:
Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc.); with femoral shaft shortening.
Summary
This procedure involves surgically treating a dislocated hip that has occurred spontaneously due to developmental, congenital, or pathological reasons. It includes repositioning and replacing the femoral head into the acetabulum (hip socket) and may involve shortening the femoral shaft to ensure a better fit and function.
Purpose
The procedure addresses hip dislocations that occur due to abnormal development, congenital conditions, or pathological factors. The goals are to restore normal hip joint function, alleviate pain, and prevent further complications by ensuring the femoral head is correctly positioned within the acetabulum.
Indications
- Spontaneous hip dislocation due to developmental, congenital, or pathological reasons.
- Chronic hip pain and immobility.
- Ineffectiveness of non-surgical treatments like physical therapy or bracing.
- Radiographic evidence of hip misalignment.
Preparation
- Patients may be required to fast for several hours prior to surgery.
- Medication adjustments may be necessary, particularly if the patient is on blood thinners.
- Pre-operative diagnostic imaging (X-rays, MRI, or CT scans) to assess the hip structure.
- Blood tests and possibly a cardiac evaluation to ensure fitness for surgery.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: An incision is made near the hip joint to gain access to the affected area.
- Femoral Head Replacement: The dislocated femoral head is repositioned into the acetabulum. Any necessary repairs or reshaping of the acetabulum are performed.
- Femoral Shaft Shortening: The femoral shaft may be shortened to improve joint congruence and function.
- Tenotomy: Tendon adjustments or releases (tenotomies) may be performed as needed.
- Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.
Setting
The surgery is performed in a hospital operating room, equipped with specialized surgical instruments and imaging technology.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site
- Blood clots or deep vein thrombosis (DVT)
- Nerve or blood vessel damage
- Leg length discrepancy
- Hip joint stiffness or limited range of motion
- Need for revision surgery
Benefits
- Restoration of normal hip alignment and function
- Significant pain relief
- Improved mobility and the ability to perform daily activities
- Prevention of further hip dislocations and associated complications
Recovery
- Initial hospital stay of 3-5 days.
- Pain management with medications.
- Physical therapy starting a few days post-surgery to regain strength and mobility.
- Restrictions on weight-bearing activities for 6 to 12 weeks.
- Follow-up appointments to monitor healing.
Alternatives
- Non-surgical methods: physical therapy, bracing, and lifestyle modifications.
- Total hip replacement surgery.
- Pros: Non-surgical options may be less invasive and have shorter recovery times.
- Cons: May not be effective for severe dislocations or for achieving long-term results.
Patient Experience
- During: Patient will be under general anesthesia and won't feel anything during the surgery.
- After: Pain and swelling managed with medication. Discomfort from the incision site.
- Gradual improvement in hip function and reduction of pain.
- Physical therapy to aid recovery and ensure optimal results.