Total Knee Arthroplasty (TKA)

CPT 27447
Approach Open
Add-on / Variant CPTs
  • 27486 — Revision total knee arthroplasty, one component
  • 27487 — Revision total knee arthroplasty, femoral and entire tibial component
Preoperative Diagnosis:

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

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] total knee arthroplasty — [implant manufacturer/model, e.g., Zimmer Persona / Stryker Triathlon]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

Spinal [/ general endotracheal] with [adductor canal block / femoral nerve block]

Indications:

The patient is a [age]-year-old [male/female] with end-stage right [left] knee osteoarthritis presenting with [X]-year history of medically refractory knee pain, functional limitation, and radiographic joint space loss. Conservative measures including physical therapy, NSAIDs, and corticosteroid injections have failed. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The knee joint demonstrated [tricompartmental / medial compartment / lateral compartment] articular cartilage loss with eburnated bone. The [medial / lateral] meniscus was [absent / degenerate]. The ACL was [absent / attenuated / intact]. Alignment was [varus / valgus / neutral] preoperatively. Component sizing was confirmed on trial reduction. Final implants: femoral component size [X], tibial tray size [X], polyethylene insert [X mm].

Description of Procedure:

The patient was positioned supine with the operative leg in a leg holder. A thigh tourniquet was applied and inflated to [275] mmHg after exsanguination with an Esmarch bandage. A midline anterior knee incision was made from [X] cm proximal to the patella to the tibial tubercle. A medial parapatellar arthrotomy was performed. The patella was everted [or subluxated].

The distal femur was prepared with the intramedullary guide set to [5°] valgus. Distal femoral resection was performed. The femoral rotation was set to [3°] external rotation relative to the posterior condylar axis. The appropriate size [X] femoral anterior-posterior, chamfer, and box cuts were made.

The proximal tibia was resected perpendicular to the tibial mechanical axis at [10] mm depth from the lowest point of the lateral plateau. The tibial size was determined and the keel prepared. The PCL was [retained / sacrificed per posterior-stabilized design].

The patella was [resurfaced with a [X]-mm poly button / not resurfaced]. Trial components were placed and range of motion, alignment, and soft tissue balance assessed — [flexion X°, extension X°, stable in varus/valgus stress]. Balance was [symmetric / required [medial / lateral] release].

The tibial tray and femoral component were cemented in place with [Palacos / Simplex] antibiotic-loaded cement. The poly insert was impacted. Tourniquet was deflated. Hemostasis was achieved. The wound was irrigated. The arthrotomy was closed with [0-Vicryl] figure-of-eight sutures. Skin was closed with [staples / 3-0 Monocryl].

Complications:

None

Specimens:

Femoral and tibial cartilage/bone specimens sent to pathology [if indicated]

Estimated Blood Loss:

[X] mL (tourniquet used — actual loss underestimated)

Drains:

None / [Hemovac drain in joint]

Disposition:

The patient was taken to the PACU in stable condition. Weight-bearing as tolerated was permitted immediately. DVT prophylaxis was initiated. Physical therapy was initiated on postoperative day 1.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left knee osteoarthritis, end-stage
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left TKA — *** implant
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Spinal + adductor canal block

INDICATIONS: .PTAGE-year-old .PTSEX with end-stage *** knee OA, failed conservative treatment. Consent obtained.

FINDINGS: *** compartment cartilage loss, eburnate bone. ACL ***. Alignment ***. Implants: femoral ***, tibial ***, poly *** mm.

PROCEDURE:
Supine. Tourniquet *** mmHg after exsanguination. Midline incision. Medial parapatellar arthrotomy. Patella everted. Distal femur resected at *** valgus, *** mm. Femoral sizing ***, rotation ***. Tibial resection perpendicular to axis, *** mm. PCL ***. Patella ***. Trials: ROM ***, balanced. Cemented with antibiotic cement. Poly inserted. Tourniquet deflated. Hemostasis. Arthrotomy closed 0-Vicryl. Skin closed.

EBL: *** mL (tourniquet)
COMPLICATIONS: None
DISPOSITION: WBAT. DVT prophylaxis. PT POD 1.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Posterior-Stabilized (PS) Design

Given PCL deficiency [/ PCL release required for deformity correction], a posterior-stabilized design was selected. The PCL was excised. The femoral box cut was made with the PS jig. The tibial post and femoral cam mechanism provide anteroposterior stability in place of the PCL. PS implants are indicated for PCL insufficiency, severe varus/valgus deformity requiring ligament release, and revision cases.

Unicompartmental Knee Arthroplasty (UKA)

Given isolated [medial / lateral] compartment disease with an intact ACL and correctable deformity, a unicompartmental arthroplasty was performed. A mini-medial parapatellar arthrotomy was used. The medial femoral and tibial surfaces were prepared with the UKA instrumentation system. A fixed-bearing [/ mobile-bearing] poly insert was used. The lateral and patellofemoral compartments were inspected and found to be well-preserved. UKA preserves bone stock, proprioception, and ACL function, with faster recovery than TKA.

Charting Tips
  • Document implant manufacturer, model, and sizes (femoral size, tibial tray size, poly thickness) in the operative note. This is required for the implant registry, FDA adverse event reporting, and future revision planning. A note that says 'TKA performed' without implant details is inadequate.
  • Document tourniquet time and pressure. Tourniquet times >90 minutes are associated with quadriceps weakness and wound complications. Document that the tourniquet was deflated and hemostasis confirmed before closure.
  • Document intraoperative alignment and balance assessment on trial components. This is the surgeon's intraoperative quality check. Document flexion/extension gap balance, varus/valgus stability, and any releases performed. This justifies the final implant selection and technique.
Billing Tips
  • Bill 27447 for total knee arthroplasty (19.11 wRVU, 90-day global). This covers standard primary TKA. Constrained, cruciate-retaining, and posterior-stabilized designs all use the same code.
  • Revision TKA uses 27486-27487 depending on extent of revision. Do not use 27447 for revision cases. Document all components revised and the reason for revision.
  • Unicompartmental knee arthroplasty (partial knee replacement) uses 27446 (17.67 wRVU, 90-day global), not 27447. Document medial vs. lateral unicompartmental vs. total knee to ensure correct code.
  • 90-day global period: physical therapy, wound checks, and routine follow-up are bundled. Manipulation under anesthesia for postoperative stiffness (27570, 6.31 wRVU) within the global period uses modifier -78.
  • Document implant specifications (manufacturer, model, lot number, sizes of femoral component, tibial baseplate, polyethylene insert, and patellar component) for mandatory implant registry reporting and medicolegal purposes.