PROSTHETIC IMPLANTS

Complete shoulder replacement, otherwise called all out shoulder arthroplasty, is the expulsion of parts of the shoulder joint, which are supplanted with counterfeit inserts to decrease torment and reestablish scope of turn and portability. It is exceptionally fruitful for treating the serious torment and firmness brought about by end-stage joint inflammation.

Shoulder joint inflammation is a condition wherein the smooth ligament that fronts of the bones of the shoulder deteriorate or break down. In a sound shoulder, these ligament surfaces grant the bones to serenely skim against each other. At the point when these ligament surfaces vanish, the bones come into direct contact, expanding erosion and making them roughen and harm one another. Bone-on bone development can be very excruciating and troublesome. Precisely embedded fake replacement surfaces reestablish torment free development, strength and capacity.

What Happens In Shoulder Replacement?

In customary shoulder replacement surgery, the harmed humeral head (the wad of the joint) is supplanted with a metal ball, and the glenoid pit (the joint attachment) is supplanted with a smooth plastic cup. (The humeral head is at the highest point of the humerus – the upper arm bone, and the glenoid is situated in the scapula – the shoulder edge.)

This metal-on-plastic embed framework (instead of metal-on-metal) is utilized in basically all shoulder replacement. In certain patients, for example, those with extreme shoulder cracks of the humeral head, an incomplete shoulder replacement (called hemi replacement) might be suggested. This method replaces the ball segment as it were.

Prosthetic Replacement Of The Shoulder Joint:

Shoulder replacement removes damaged areas of bone and replaces them with parts made of metal and plastic (implants). This surgery is called shoulder arthroplasty (ARTH-row-plas-tee).

The shoulder is a ball-and-socket joint. The round head (ball) of the upper arm bone fits into a shallow socket in the shoulder. Damage to the joint can cause pain, weakness and stiffness.

Shoulder implants are available in a few different shapes and a range of sizes. Replacement options include partial and total using either anatomic or reverse implants.

When is a shoulder prosthesis required?

Shoulder replacement surgery is required when the shoulder joint is destabilized to the extent that the arm can no longer be used without pain. This lack of pain free mobility in the joint, may be due to osteoarthritis, or following traumatic injury to the shoulder.

Implantation of a shoulder endoprosthesis is necessary if the wear or damage to the shoulder joint is so advanced, that non-operative and/or joint-preserving operations do not solve the problem.

This is often found in cases of advanced arthritis of the shoulder joint (osteoarthritis) where the wear on the articular cartilage surfaces (primary osteoarthritis) is particularly painful and movement has become extremely restrictive.

Furthermore, severe fractures or injuries to the upper arm humerus (glenoid fracture), changes in the blood flow to the humeral head (necrosis of the humeral head), rheumatic diseases (chronic polyarthritis), instability (chronic shoulder dislocation), or severe joint infection (omarthritis), lead to the damage and wear of the articular surfaces (Secondary osteoarthritis).

Causes

Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is an age-related wear-and-tear type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.

Unfortunately, there is no way to prevent the development of osteoarthritis. It is a common reason people have shoulder replacement surgery.

Rheumatoid Arthritis

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed inflammatory arthritis.

Post-traumatic Arthritis

This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time. This causes shoulder pain and limits shoulder function.

Rotator Cuff Tear Arthropathy

A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.

Avascular Necrosis (Osteonecrosis)

Avascular necrosis, or osteonecrosis, is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are all risk factors for avascular necrosis.

Severe Fractures

A severe fracture of the shoulder is another common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for severe shoulder fractures.

Failed Previous Shoulder Replacement Surgery

Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

Shoulder replacement procedures

Depending on the type of joint damage you have, your doctor may recommend one of the following shoulder replacement options:

• Anatomic total shoulder replacement. Both the ball and the socket are replaced. The implants resemble the natural shape of the bones.
• Reverse total shoulder replacement. Both the ball and the socket are replaced, but the implants are reversed. The ball is attached to the shoulder blade and the socket is attached to the upper arm bone. This option typically is preferred if the rotator cuff is severely damaged.
• Partial shoulder replacement. Only the head (ball) of the joint is replaced. It may be recommended when only the ball side of the joint is damaged.

With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.

Prosthetic replacement of the elbow joint:   

Elbow replacement surgery removes damaged areas of the elbow joint and replaces them with parts made of metal and plastic (implants). This surgery is also called elbow arthroplasty.

Three bones meet in the elbow. The upper arm bone (humerus) connects like a loose hinge to the larger of the two forearm bones (ulna). The two forearm bones (radius and ulna) work together to provide rotation.

Traditionally, elbow replacement surgery has had a higher rate of complications than surgeries to replace hip or knee joints. But recent advances in surgical technique and implant design have improved the success rate of elbow replacements.

Causes

Several conditions can cause elbow pain and disability, and lead patients and their doctors to consider elbow joint replacement surgery.

Rheumatoid Arthritis

Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis." This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is an age-related, wear and tear type of arthritis. It usually occurs in people age 50 and older but may occur in younger people, too. The cartilage that cushions the bones of the elbow softens and wears away. The bones then rub against one another. Over time, the elbow joint becomes stiff and painful.

Posttraumatic Arthritis

This type of arthritis can follow a serious elbow injury. Fractures of the bones that make up the elbow, or tears of the surrounding tendons and ligaments may cause damage to the articular cartilage over time. This causes pain and limits elbow function.

Severe Fractures

A severe fracture of one or more bones that make up the elbow is another common reason people have elbow replacements. If the elbow is shattered, it may be very difficult for a surgeon to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this type of case, a surgeon may recommend an elbow replacement. 

In addition, some fractures do not heal well and may require an elbow replacement to address continuing problems.

Older patients with osteoporosis (fragile bone) are most at risk for severe elbow fractures.

Instability

Instability occurs when the ligaments that hold the elbow joint together are damaged and do not work well. The elbow is prone to dislocation.

Chronic instability is most often caused by an injury.

Elbow replacement procedures

In some cases, you may need a replacement of just one portion of the joint. For example, if only the head of one of your forearm bones (radius) is damaged, it can be replaced with an artificial head.

If the entire joint needs to be replaced, the ends of the bones that come together in the elbow will be reshaped. Bones are hard tubes that contain a soft center. The long, slender ends of the artificial parts are inserted into the softer central part of the bones.

If the surrounding ligaments aren't strong enough to hold the joint together by themselves, the surgeon may use a linking cap so that the artificial implants can't come apart

 

With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.

Prosthetic replacement of wrist joint:

Wrist replacement, also referred to as wrist arthroplasty is a surgical procedure in which the diseased or damaged joint is replaced with an artificial joint- a prosthesis. It aims to create a stable, pain-free joint with a functional range of movement when conservative treatments have failed.

Total wrist arthroplasty (TWA) is a motion preserving alternative to arthrodesis of the wrist and usually lasts for about 10 to 15 years. Implant survival of 90-100% at five years are mostly reported using newer second generation and third generation implants, but declines from five to eight years.

Total wrist replacements are non weight bearing joints; heavy household or occupational activity, use of a walking aid or repetitive movements e.g. hammering will increase the speed and incidence of loosening of the implants stems and the ultimate failure of the implant. The ideal patient for a TWA should have a low demand lifestyle, should not need the upper extremity for regular ambulation and transfers. 

Causes

If the cartilage is worn away or damaged by age, injury, infection, or disease, the bones will rub against each other, wearing out the ends of the bones. This causes an often a painful arthritic condition.

Osteoarthritis, the most common form of arthritis, results from a gradual wearing away of the cartilage covering on bones. Osteoarthritis is typically caused by advanced age and many years of use.

Rheumatoid arthritis is a chronic inflammatory disease of the joints that results in pain, stiffness and swelling. Rheumatoid arthritis usually affects several joints on both sides of the body. it is caused by autoimmune disease that causes the body to attack its own joints.

Posttraumatic arthritis is caused by trauma or injury to the joints. This form of arthritis is most similar to osteoarthritis. However, the onset of posttraumatic arthritis is less gradual than osteoarthritis and, unlike osteoarthritis, it can be traced back to a traumatic event (e.g., a broken bone during a car accident).

All forms of arthritis may affect the strength and motion of the wrist and result in limited use of the hand.

 

Procedure

Wrist joint replacement can be done as an outpatient procedure, meaning the patient can go home the day of surgery. Wrist replacement surgery can also be combined with other procedures to correct deformities or disorders in the tendons, nerves, and small joints of the fingers, and thumb.

With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214

Note: The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under §4.30 following hospital discharge.

Prosthetic replacement of the head of the femur or of the acetabulum:

Hip replacement, also called hip arthroplasty, is a surgical procedure to address hip pain. The surgery replaces parts of the hip joint with artificial implants. The hip joint consists of a ball (at the top of the femur, also known as the thigh bone) and a socket (in the pelvis, also known as the hip bone). Hip replacement surgery includes replacement of one or both parts. The goal of the procedure is to allow you to resume daily activities and exercise with less pain.

Why Is Hip Replacement Surgery Done?

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:

Osteoarthritis

Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.

Rheumatoid arthritis

Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.

Osteonecrosis

If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.

Hip replacement may be an option if hip pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from a seated position

What are the different types of hip replacement surgery?

The three major types of hip replacement are:

• total hip replacement (most common)
• partial hip replacement
• hip resurfacing

The most common type of hip replacement surgery is called a total hip replacement (also called total hip arthroplasty). In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. The socket is replaced with a durable plastic cup, which may or may not also include a titanium metal shell. Your femoral head will be removed and replaced with a ball made from ceramic or a metal alloy. The new ball is attached to a metal stem that is inserted into the top of your femur. 

About Knee Replacement:

Absolute knee replacement: A surgery where harmed portions of the knee joint are supplanted with artificial parts.

The medical procedure is finished by isolating the muscles and tendons around the knee to uncover within the joint. The finishes of the thigh bone (femur) and the shin bone (tibia) are taken out as is regularly the underside of the kneecap (patella). The fake parts are then solidified into place.

What Happens During Knee Replacement?

These pieces might be put in the accompanying spots in the knee joint:

• Lower thigh bone - This bone is known as the femur. The new part is usually made of metal.
• Upper finish of the shin bone, which is the enormous bone in your lower leg - This bone is known as the tibia. The new part is generally produced using metal and solid plastic.
• Posterior of your kneecap - Your kneecap is known as the patella. The new part is typically produced using a solid plastic.

You won't feel any torment during the medical procedure. You will have one of these two sorts of sedation:

General Sedation

- This implies you will be snoozing and incapable to feel torment.

Provincial (Spinal Or Epidural) Sedation

- Medicine is placed into your back to make you numb underneath your midsection. You will likewise get medication to make you tired. What's more, you may get medication that will cause you to disregard the technique, despite the fact that you are not completely sleeping.

• After you get sedation, your specialist will make a slice over your knee to open it up. This slice is regularly 8 to 10 inches (20 to 25 centimeters) in length. At that point your specialist will:
• Move your kneecap (patella) far removed, at that point cut the finishes of your thigh bone and shin (lower leg) bone to fit the new part.
• Cut the underside of your kneecap to set it up for the new pieces that will be joined there.
• Secure the two pieces of the prosthesis to your bones. One section will be appended to the furthest limit of your thigh bone and the other part will be joined to your shin bone. The pieces can be appended utilizing bone concrete or screws.
• Connect the underside of your kneecap. An extraordinary bone concrete is utilized to append this part.
• Fix your muscles and ligaments around the new joint and close the careful cut.
• The medical procedure requires around 2 hours.

Most counterfeit knees have both metal and plastic parts. A few specialists currently utilize various materials, remembering metal for metal, earthenware on artistic, or ceramic on plastic.

Knee replacement (prosthesis)

Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.

The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.

Why Is Knee Replacement Surgery Done?

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have knee pain at rest.

Diagnostic Procedures

Before a TKA surgery, a full medical evaluation is performed to determine risks and suitability. As part of this evaluation, imaging is used to assess the severity of joint degeneration and screen for other joint abnormalities. A knee radiograph is performed to check for prosthetic alignment before the closure of the surgical incision.

Prosthetic replacement of ankle joint:

Ankle replacement surgery is the replacement of a damaged ankle joint with an artificial implant. The ankle joint (tibiotalar joint) is where your shinbone (tibia) rests on top of a bone of your foot, the talus.

Arthritis can affect this joint as well as other joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This can result in pain, inflammation, and swelling of your joint.

Ankle replacement surgery is a procedure to replace this damaged joint to eliminate this pain and swelling. Typically, the procedure takes place under general anesthesia. Your surgeon will make an incision in your ankle to access the affected joint. Next, your surgeon will remove the damaged parts of your tibia and talus bones. Your surgeon will attach artificial metal joints to the remaining bone surfaces, with a piece of plastic inserted between them.

Why the Procedure is Performed

This surgery may be done if the ankle joint is badly damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

• Arthritis caused by ankle injuries or surgery in the past
• Bone fracture
• Infection
• Osteoarthritis
• Osteonecrosis
• Rheumatoid arthritis
• Tumor

What are the risks and benefits of ankle replacement?

An ankle replacement helps you regain strength and stability in your ankle. The treatment also preserves range of motion. The replacement parts articulate, or move together, like your natural joint. This flexibility can allow you to walk normally, with less pain, and return to a more active lifestyle.

Often, ankle replacement is preferable to ankle fusion (arthrodesis). Fusion surgery permanently joins the ankle bones together, limiting range of motion. This loss of flexibility can affect the way you walk or cause arthritis to develop in other joints. Talk to your provider about which procedure — ankle replacement or ankle fusion — best fits your unique needs.

Although rare, ankle surgery can lead to complications. Possible risks of ankle replacement include:

• Blot clots.
• Infection.
• Loosening of replacement parts, requiring a procedure to repair.
• Nerve or blood vessel damage.
• Problems healing the incision.
• Wearing down of metal and plastic replacement parts over time.

Note: The term "prosthetic replacement" in diagnostic codes 5051 through 5056 means a total replacement of the named joint.  However, in DC 5054, "prosthetic replacement" means a total replacement of the head of the femur or the acetabulum.

Note (1): The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge.

Note (2): Special monthly compensation is assignable during the 100 pct rating period the earliest date permanent use of crutches is established.

combinations of disabilities