Total Hip Arthroplasty (THA)

CPT 27130
Approach Open
Add-on / Variant CPTs
  • 27132 — Conversion of previous hip surgery to total hip arthroplasty
  • 27134 — Revision total hip arthroplasty, both components
Preoperative Diagnosis:

Right [left] hip osteoarthritis, end-stage, not responsive to conservative management

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] total hip arthroplasty via [posterior / direct anterior] approach, [implant manufacturer/model]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

Spinal [/ general endotracheal]

Indications:

The patient is a [age]-year-old [male/female] with end-stage right [left] hip osteoarthritis presenting with refractory hip pain and functional impairment. Conservative management including physical therapy and analgesics has been exhausted. Radiographs demonstrate loss of joint space, subchondral sclerosis, and osteophyte formation. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The femoral head was [spherical / flattened / osteophytic]. Articular cartilage was absent with eburnated bone on both the femoral head and acetabulum. The femoral head measured [X] mm in diameter. Implants: [X]-mm [hemispherical] acetabular cup at [40°] inclination/[15°] anteversion, [X]-mm femoral stem, [X]-mm [ceramic / cobalt-chrome] head, [X]-mm poly liner.

Description of Procedure:

[POSTERIOR APPROACH:]
The patient was positioned in the lateral decubitus position with the operative hip up. A [X]-cm posterior incision was made centered over the greater trochanter. The fascia lata was incised. The short external rotators (piriformis, obturator internus, gemelli) were tagged and divided at the greater trochanter. The posterior capsule was incised and the hip was dislocated posteriorly by internal rotation, adduction, and flexion.

The femoral neck was cut at the planned level with an oscillating saw. The femoral head was removed and measured. The acetabulum was prepared with sequential reamers to [X] mm. A press-fit [X]-mm acetabular shell was impacted at [40°] inclination and [15°] anteversion. [X] screws were placed for additional fixation. A [cross-linked poly / ceramic] liner was impacted.

The femoral canal was prepared with the broach sequence to size [X]. The femoral stem was trialed and leg length, offset, and stability assessed. The final [uncemented / cemented] [X] stem was implanted. A [X]-mm head was assembled. The hip was reduced and stability tested. Stable through [0–90° flexion] with no impingement.

The posterior capsule and short external rotators were repaired to the posterior greater trochanter with [No. 2 FiberWire] sutures through bone tunnels. The fascia lata was closed with [0-Vicryl]. Skin was closed with [staples / 3-0 Monocryl].

Complications:

None

Specimens:

Femoral head sent to pathology [if indicated]

Estimated Blood Loss:

[X] mL

Drains:

None / [Hemovac drain]

Disposition:

The patient was taken to the PACU in stable condition. Weight-bearing as tolerated with posterior hip precautions [/ no hip precautions — anterior approach]. DVT prophylaxis was initiated. Physical therapy was initiated on postoperative day 1.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left hip osteoarthritis, end-stage
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left THA, *** approach — *** implant
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Spinal

INDICATIONS: .PTAGE-year-old .PTSEX with end-stage hip OA, failed conservative management. Consent obtained.

FINDINGS: Femoral head ***. Cartilage absent, eburnate. Implants: *** mm cup at 40°/15°, *** stem, *** mm head, *** liner.

PROCEDURE:
Lateral decubitus, operative hip up. Posterior incision. Fascia lata incised. Short external rotators tagged and divided. Posterior capsule incised, hip dislocated posteriorly. Femoral neck cut at planned level. Head removed, *** mm. Acetabulum reamed to *** mm, *** mm shell impacted 40°/15°, *** screws. *** liner impacted. Femoral canal broached to size ***. Trial: stable, LL/offset confirmed. Final stem implanted. Head assembled. Hip reduced — stable. Posterior capsule/short external rotators repaired to GT via bone tunnels. Fascia closed. Skin closed.

EBL: *** mL
COMPLICATIONS: None
DISPOSITION: WBAT with *** precautions. DVT prophylaxis. PT POD 1.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Direct Anterior Approach (DAA)

The patient was positioned supine on a [traction / standard] table. An anterior incision was made in the interval between the tensor fascia lata (TFL) and sartorius, utilizing the Smith-Petersen internervous plane (lateral femoral cutaneous nerve preserved). The hip capsule was incised in H-fashion. Hip dislocation was achieved with traction, external rotation, and hyperextension. Acetabular and femoral preparation proceeded as described. DAA avoids division of the short external rotators, permits earlier return to function, and eliminates the need for posterior hip precautions. Lateral femoral cutaneous nerve injury is a recognized approach-specific complication.

Hip Hemiarthroplasty (Femoral Neck Fracture)

Given displaced femoral neck fracture in a [low-demand / elderly] patient, hemiarthroplasty was performed rather than THA. The fractured femoral head was removed and sent to pathology. Only the femoral component and bipolar head were implanted; the native acetabular cartilage was retained. A [unipolar / bipolar] [X]-mm femoral head was assembled. Hemiarthroplasty is appropriate for elderly low-demand patients with displaced femoral neck fractures; THA is preferred for active patients with pre-existing acetabular disease.

Charting Tips
  • Document cup inclination and anteversion. The 'safe zone' for acetabular component position is 40° ± 10° inclination and 15° ± 10° anteversion. Document the measured intraoperative angles. Malposition is the leading cause of instability and wear-related failure.
  • Document posterior capsule and short external rotator repair for posterior approach. This is the most important step in reducing posterior dislocation risk. The repair technique (bone tunnels, suture anchors, direct capsulorrhaphy) should be documented.
  • Document leg length and offset comparison to the contralateral side. Leg length discrepancy >1 cm is a common source of patient dissatisfaction and litigation. Document intraoperative assessment method (radiographic template, caliper measurement) and final result.
Billing Tips
  • Bill 27130 for primary total hip arthroplasty (19.11 wRVU, 90-day global). Bill 27132 for total hip arthroplasty after failed hemiarthroplasty or conversion from prior fixation (25.05 wRVU, 90-day global).
  • Revision THA uses 27134-27138 depending on components revised. Do not use 27130 for revision cases, as revision codes have higher wRVU and different documentation requirements.
  • Direct anterior approach, posterior approach, and lateral approach all use the same code (27130). Approach does not change the CPT. Document the approach, implant specifications (manufacturer, size, bearing surface), and press-fit vs. cemented technique.
  • 90-day global period: DVT prophylaxis management, physical therapy, and routine X-ray checks are bundled. Manipulation under anesthesia for stiffness or dislocation reduction requiring sedation within the global period uses modifier -78.
  • Implant registry documentation is required: record manufacturer, model, lot number, and size of cup, liner, femoral stem, and head for each case. Most states mandate orthopedic implant registry reporting.