september 2017

Distal Radioulnar Joint Arthroplasty

The area where the distal ulna and radius articulate is called the sigmoid notch. When a patient has arthritis in the area of the sigmoid notch, it can limit the amount of pronation and/or supination that can be achieved at this joint and the patient can also suffer from extreme pain during these maneuvers.   

When performing a distal radioulnar joint arthroplasty the distal end of the ulna is removed and like most other arthroplasty procedures the medullary canal is reamed so that it can accept the metal shaft with a polymer type ball at the head of the ulnar implant. Once this is in place there is a “plate” which is affixed to the side of the radius. The ulnar ball shaped head is then placed into the depression on the radial plate and a cap fits over the ball to hold this construct in place.

For the purposes of coding you would only report CPT code 25442 Arthroplasty with prosthetic replacement; distal ulna. Since a plate is only placed on the radius to act as an anchor point and no portion of the distal radius is being replaced you would not report 25441 Arthroplasty with prosthetic replacement; distal radius for this type of procedure.



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