0SRB019
Replacement Hip Joint, Left to Cemented with Synthetic Substitute, Metal, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | S Lower Joints |
| Operation | R Replacement |
| Body Part | B Hip Joint, Left |
| Approach | 0 Open |
| Device | 1 Synthetic Substitute, Metal |
| Qualifier | 9 Cemented |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
Joint replacement in the lower extremities involves removing damaged or arthritic surfaces of a hip, knee, or ankle and implanting an artificial device that takes over the joint's function. Surgeons turn to this once medications, injections, and physical therapy no longer control the pain or stiffness of advanced osteoarthritis, rheumatoid arthritis, avascular necrosis, or a joint destroyed by prior trauma. The goal is restoring the ability to walk, climb stairs, and move without bone grinding on bone.
Implants are made of metal alloys, ceramic, or high-grade polyethylene, and a case can replace an entire joint (total) or a single compartment (partial). Recovery centers on physical therapy to build strength around the new joint; most patients regain substantial function within a few months, though the device will eventually wear and may need revision decades later.
Anatomy & Axis Detail
Hip Joint, Left
When the code for the hip joint itself (rather than its acetabular or femoral surface) is used for Replacement, it reflects a hemiarthroplasty in which a prosthetic femoral head component is inserted to articulate directly against the patient's native acetabulum, without a matching prosthetic socket. This approach is common after a displaced femoral neck fracture in an older or lower-demand patient, where preserving the native acetabular cartilage avoids the added operative time and dislocation risk of a total replacement. Because only one side of the joint receives a device, the surgeon's documentation of whether the acetabulum was resurfaced is essential to selecting the correct code, since any prosthetic acetabular component would instead require the acetabular surface body part.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Device: Synthetic Substitute, Metal
Synthetic Substitute, Metal describes a joint replacement component made entirely of metal, historically used in some hip resurfacing and metal-on-metal bearing designs where both articulating surfaces are metallic. It is distinguished from combination bearings such as Metal on Polyethylene, where only one surface is metal, and from single-material Ceramic or Polyethylene substitutes. Metal-on-metal designs have specific wear-particle considerations that shaped their more limited current use.
Qualifier: Cemented
Cemented qualifies a joint replacement procedure by indicating that the prosthetic component was fixed to bone using bone cement rather than relying on bony ingrowth. It is distinguished from the Uncemented qualifier, with the choice affecting expected fixation strength, recovery timeline, and revision considerations.
Coding & Documentation
A coder assigns Replacement when the operative note documents removal of the native articular surface and insertion of a device meant to permanently substitute for it, not merely resurface it. Documentation should specify the joint, laterality, and whether the procedure was total or partial, since these drive qualifier selection. A common error is confusing partial resurfacing that leaves native bone intact with full Replacement, or missing that a revision arthroplasty swapping the entire prosthesis is still Replacement rather than Revision.