27130

Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without cement; primary

Total hip arthroplasty (THA), also known as total hip replacement, is a surgical procedure in which the diseased or damaged bone and cartilage of the hip joint are removed and replaced with prosthetic components. This primary procedure involves resurfacing the acetabulum (hip socket) with a prosthetic cup and liner, and replacing the femoral head and neck with a prosthetic stem and ball component. The components may be secured with or without bone cement, depending on surgical technique and patient factors. The goal is to relieve pain, improve joint function, and restore mobility in patients with severe degenerative or inflammatory hip conditions.

Clinical Indications

  • Severe osteoarthritis of the hip (degenerative joint disease) that has failed conservative management (e.g., physical therapy, medications, injections)
  • Rheumatoid arthritis or other inflammatory arthropathies causing significant hip destruction and pain
  • Avascular necrosis (osteonecrosis) of the femoral head leading to collapse and severe pain
  • Post-traumatic arthritis causing chronic pain and functional impairment
  • Certain hip fractures (e.g., displaced femoral neck fractures) in active elderly patients, where hemiarthroplasty is deemed insufficient or inappropriate
  • Developmental dysplasia of the hip (DDH) or other congenital hip deformities with advanced degenerative changes
  • Tumors of the hip joint requiring resection and reconstruction

Procedure Steps

  1. Patient positioning (typically lateral or supine) and sterile preparation of the surgical site
  2. Surgical approach (e.g., posterior, anterior, anterolateral) to expose the hip joint
  3. Incision through skin, subcutaneous tissue, and muscle layers to access the joint capsule
  4. Dislocation of the femoral head from the acetabulum
  5. Resection of the femoral head and neck
  6. Preparation of the acetabulum: reaming to create a hemispherical surface for the acetabular component
  7. Implantation of the acetabular component (shell and liner), often involving screw fixation or press-fit techniques
  8. Preparation of the femoral canal: reaming and broaching to size for the femoral stem
  9. Implantation of the femoral stem into the femur, with or without cement
  10. Attachment of the prosthetic femoral head to the stem
  11. Reduction of the hip joint (placement of the new femoral head into the new acetabular cup)
  12. Assessment of hip stability, range of motion, and leg length
  13. Closure of the joint capsule, muscle layers, subcutaneous tissue, and skin
  14. Application of sterile dressings

Coding Guidelines

  • CPT code 27130 describes a primary total hip arthroplasty, encompassing the replacement of both the acetabular and proximal femoral components.
  • This code has a 90-day global surgical period, meaning all routine pre-operative care, the surgery itself, and routine post-operative care for 90 days are included in the reimbursement.
  • Components included in 27130 typically include the acetabular shell, acetabular liner, femoral stem, and femoral head. Separate coding for these individual components is not appropriate.
  • Bilateral procedures should be reported with CPT code 27130 and modifier -50 (Bilateral Procedure). Check payer-specific guidelines for proper reporting (e.g., two units or 27130-RT, 27130-LT).
  • This code does not include revision arthroplasty procedures, which are reported with different codes (e.g., 27134, 27137, 27138).
  • Bone grafts (e.g., allograft, autograft) performed during the total hip arthroplasty may be separately reportable with appropriate codes (e.g., 20900, 20902) if significant and not considered an inherent part of the primary procedure. Documentation must support medical necessity and separate work.
  • Any removal of previously implanted hardware (e.g., pins, screws) from a prior surgery, if performed as a significant and distinct procedure prior to the THA, might be separately reportable, depending on payer rules and documentation.
  • Fluoroscopic guidance, if used for component positioning, is generally considered an inherent part of the procedure and not separately billable.

Associated ICD-10 Codes