0SPC3JC
Removal Knee Joint, Right to Patellar Surface with Synthetic Substitute, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | S Lower Joints |
| Operation | P Removal |
| Body Part | C Knee Joint, Right |
| Approach | 3 Percutaneous |
| Device | J Synthetic Substitute |
| Qualifier | C Patellar Surface |
Operation Definition
Taking out or off a device from a body part
Procedure Overview
Removal procedures take out a device that was previously placed in a lower joint, such as internal fixation hardware, a spacer, drainage tubing, or an external fixator frame. These procedures are performed once the device has served its purpose - for example, after a fracture has healed and screws are no longer needed - or when a device is causing pain, infection, or mechanical irritation and needs to come out. Removal can be a planned, staged part of treatment or an unplanned procedure prompted by a complication.
Because the device itself, not the joint tissue, is the focus, these procedures are typically less extensive than the original surgery that placed the device, though scar tissue and bony ingrowth around older hardware can make removal technically demanding.
Anatomy & Axis Detail
Knee Joint, Right
The right knee joint is a complex hinge articulation among the femur, tibia, and patella, stabilized by an extensive network of ligaments and menisci that make it one of the most frequently instrumented joints in orthopedic surgery. Removal here refers to extracting a foreign or nonbiological substance from within the joint space - retained cement, loose hardware fragments, or debris from a prior arthroplasty, ligament reconstruction, or fracture fixation - without repairing the joint structures themselves. The knee's relatively superficial location compared to the hip makes retrieval more directly accessible, often through the same anterior or medial parapatellar approaches used in arthroplasty revision. Persistent pain, mechanical symptoms, or imaging evidence of a displaced fragment typically prompts this procedure.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Device: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
Qualifier: Patellar Surface
Patellar Surface qualifies a knee joint replacement procedure by indicating that the component addressed the back of the kneecap rather than the femoral or tibial articulating surfaces. Its inclusion or omission reflects whether the patella was resurfaced as part of the arthroplasty.
Coding & Documentation
The operative note must identify the specific device being taken out and confirm nothing is being put in its place; if a new device replaces the old one, the more specific combination root operation (such as Revision) may apply instead of a plain Removal. The body part coded is the joint from which the device is taken, using the device's original insertion site. A recurring error is coding Removal when hardware is being exchanged for a different device during the same procedure, which should instead be captured as Revision, or when the device is being taken out specifically because it failed, which some coders mistakenly still classify simply as Removal without checking whether Revision criteria are met.