$35/hr per hour by MDs
Billable Expense
646-470-8730
Jane Smith
DOB-XX/XX/XXXX
Hip Surgery Details:
 07/29/XXX - Left Total Hip Arthroplasty
 11/17/XXXX - Revision of Left Total Hip Replacement
DATE
XX/XX/2006
PROVI
DER
XXXX
Clinic
XXXX
Finley,
M.D.
OCCURRENCE/TREATMENT
Follow-up for Left Hip and Low Back Pain: Patient had a fall in October and she
developed constant pain with radiation down the leg since then.
PDF
REF
21-22, 133
Impression: Osteoarthritis of left hip with posttraumatic component secondary to
previous to previous slipped capitol femoral epiphysis.
Plan: Total hip replacement was planned if she did not improve with injection.
Patient underwent Left Total Hip Arthroplasty- James S. Finley, M.D.
41, 42
Pre and Postoperative Diagnosis: Traumatic arthritis of left hip.
XX/XX/2008
XXXX
Medical
Center
XXXX,
M.D.
(Ortho
Surgery)
XX/XX/2010
XXX
General
Hospital
XX/XX/2010
XXX
Clinic
XXXX
Clinic
XX/XX/2010
Roy
XXXX,
M.D.
Richard
XXX,
M.D.
Detailed Procedure Notes: The labrum of the acetabulum was debrided back by
sharp dissection and the acetabulum was progressively reamed up to a 51 diameter
and a 52 acetabular cuff was impacted into the acetabulum. This seated fully and had
excellent stability.
Implant Details:
 DePuy ASR TM Taper Sleeve Adaptor; REF #: XXXX-XX-XXX; LOT#:
2XXXX
 DePuy AST TM Uni Femoral Implant; REF#: 9998-XX-XXX; LOT#
2XXXXXX; Size:48
 DePuy ASR TM Acetabular Cup; REF#: 9998-XX-XXX; LOT#:
2XXXXXX; Size:52
 DePuy France Co rail; LOT#: 2XXXX
Patient presented to the triage with hip pain. The quality was acute and the severity
was moderate. She fell at home onto left hip.
On examination, she had pain to left hip with range of motion. She was diagnosed as
contusion to left hip. She was prescribed medications and was sent home.
NM Whole Body Scan showed increased activity within the region of left proximal
femur which could represent prosthesis loosening.
Patient underwent Revision of Left Total Hip Replacement under general
anesthesia. - Richard XXXX, M.D.
Pre and Postoperative Diagnosis: Failed hip prosthesis.
Procedure in Detail: Once this was cleared, the hip was reduced and the femoral
head was removed from the femoral component. The proximal portion of the femoral
component was cleared of soft tissue circumferentially; bone overlap was removed.
Then attempts were made to remove the femoral component. It was also noted that
from the time the femoral component was exposed, it had some looseness in an
anterior posterior plane, and to a lesser extent, medial-lateral plane. With
1 of 2
70-71
1, 3-8
126
49, 58, 8889
DATE
XX/XX/2010
PROVI
DER
(Orthope
dic
Surgeon)
XXX
Clinic
Surgical
Hospital
Richard
XXXX,
M.D.
OCCURRENCE/TREATMENT
dissection, there was found to be some synovium going into the space between
the femoral component and the proximal femur. This was consistent with the
findings of the bone scan. However, it was incredibly difficult to remove the stem
with attempts being made using an extraction device, sequential attempts to dissect
around the stem and, after an extended period and extensive attempts, the femoral
component could not be removed. An osteotomy of the proximal femur was carried
out, and once this was opened, it was found that the stepped portion of the
component did have good bite more distal and the stem was removed. Cables were
then used to go around the area of the osteotomy. At this point, sequential reaming
and rasping was carried out and it was found that a long stem porous femoral
component was appropriate. Attention was turned to the acetabulum and the
acetabular component which had been cleared of soft tissue was removed with
minimal difficulty, tapping on a femoral impactor and dislodging the acetabular
component. On its removal, there was no obvious bony ingrowth whatsoever.
Sequential reaming was carried out to a size 56 outer diameter.
Discharge Summary
Patient was followed for progressive pain in her hip. She was struck by a vehicle in a
parking lot and had persistent pain since that time. Work up revealed loosening of
femoral component of the hip. She was found to have had one of the recalled hips
implanted, and was decided to proceed with revision of both components of hip
prosthesis. She underwent revision of hip prosthesis and did well postoperatively.
She had perioperative anemia and received 2 units of packed red blood cells. She
was stable and was discharged to XXXX Nursing and Rehab. She had an episode of
drainage of what appeared to be old hematoma with mobilization, but had stopped.
She had no problems at the time of discharge.
2 of 2
PDF
REF
21, 117119, 158,
162-164