CPT® Code 27138

The CPT® Code 27138 refers to the procedure known as the revision of total hip arthroplasty, specifically focusing on the femoral component only, with or without the use of allograft. This surgical intervention is typically indicated when a previously implanted total hip prosthesis has failed, necessitating a revision to restore function and alleviate pain. The procedure involves a series of meticulous steps, beginning with the incision along the previous surgical site on the lateral aspect of the hip. Surgeons must carefully dissect the soft tissue, which may involve extensive release of scar tissue that has formed around the hip joint. This may include partial releases of the psoas tendon, gluteus maximus insertion, and the head of the rectus femoris muscle to gain adequate access to the hip joint. Once the hip is dislocated, the femoral head prosthesis is exposed for removal. The acetabular component is also addressed, requiring the excision of the pseudocapsule and removal of the acetabular cup. The femoral component's removal may involve techniques such as using a high-speed burr to eliminate any trochanteric overhang or performing a trochanteric osteotomy if necessary. The procedure also includes clearing the proximal femoral stem of any bone cement or bony overgrowth, which is crucial for the successful implantation of the new components. Depending on the condition of the existing prosthesis, the removal may require additional measures to sever any fibrous or bony ingrowth. After the old components are removed, the surgical site is thoroughly cleaned, and any bone loss is evaluated to determine the need for bone grafting. The final step involves the implantation of the revised femoral component, ensuring that the hip joint is restored to its intended function.