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Knee Anatomy for Arthroplasty procedure

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1.What type of joint is the knee?                                                                             

Knee joint is hinge joint based on movement and a synovial joint.

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2. How many bone make knee joint ?                                                                                 

There are three bones joined together to form knee joint

1.Femur

2.Tibia

3.Patella

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3. What is Synovial Joint?                                                                                                          

A synovial joint is a type of joint in the body where two bones are connected by a cavity filled with synovial fluid, which allows for smooth, friction-free movement.

 

4.What is joint capsule? 

The joint capsule is a tough, fibrous structure that surrounds and encloses a synovial joint, such as the knee. It helps stabilize the joint and contains the synovial fluid, which lubricates the joint to reduce friction and allow smooth movement.

The joint capsule has two main layers:

1.Outer fibrous layer: This is a tough, fibrous tissue that provides strength and stability to the joint.

2.Inner synovial membrane: This membrane lines the inside of the joint capsule and produces synovial fluid to lubricate the joint.

 

5.What is synovial membrane ? 

The synovial membrane is the inner lining of the joint capsule in a synovial joint. Its main function is to produce synovial fluid, a thick, slippery substance that lubricates the joint, reducing friction between the bones and allowing for smooth movement.

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6.What is Bursa?                                                                                                                         

A bursa is a small, fluid-filled sac that acts as a cushion between bones, tendons, and muscles around a joint. Its main function is to reduce friction and allow smooth movement of these structures over one another.
 

7.What is meniscus of Knee ? 

The meniscus in the knee refers to a pair of crescent-shaped cartilage structures located in the knee joint.

There are two menisci in each knee: the medial meniscus (on the inner side of the knee) and the lateral meniscus (on the outer side of the knee).

hese menisci act as shock absorbers and provide stability to the knee by helping to distribute body weight evenly across the joint.

 

8.What is synovitis and busitis and what procedure performed to treat this?

Synovitis is the inflammation of synovial membrane and synovectomy is performed to treat this.

Bursitis is the inflammation of bursa and Bursectomy is performed to treat this.

 

9.What is tibial Plateau? 

The tibial plateau is the flat, upper surface of the tibia (shinbone), which forms the lower part of the knee joint.

 

10.What is femoral condyle ? 

The femoral condyles are two rounded bony prominences situated at the distal end of the femur (thigh bone).

 

11.How many compartments are there in the knee ? 

There are three compartment in the knees

1. Medial compartment

2. Lateral Compartment

3. Patellofemoral compartment

 

12.How many ligaments are there in the knee? 

There are total five ligament in the knee

1. Anterior cruciate ligament

2. Posterior cruciate ligament

3. Medial collateral ligament

4. Lateral Collateral ligament.

5. Anteriolateral ligament

 

13.What is intra-articular ligament?  

The intra-articular ligaments of the knee are the Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL), located within the knee joint capsule.

 

14.What is extra-articular ligament?  

The major extra-articular ligaments of the knee, located outside the joint capsule, are the medial collateral ligament (MCL), lateral collateral ligament (LCL), and anterolateral ligament (ALL).

 

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Arthroplasty procedure : Interview Question

 

1.What is Knee Arthroplasty ?  

Knee Arthroplasty is the replacement of the knee joint.

 

2.What is the medical necessity of knee arthroplsty ?

Osteoarthritis is common reason behind knee arthroplasty.

 

3.What is total knee arthroplasty ?

In this both medial and lateral part of tibia with plateau along with femoral condyle is replaced with an artificial implant.

CPT Code  27447 : Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

 

4.What is prosthesis ?

A prosthesis  is an artificial device that is used to replace a missing or damaged body part.

 

5.What is partial knee arthroplasty ?

In this only one either medial and lateral part of tibia with plateau along with femoral condyle is replaced with an artificial implant.

CPT Code  27446 :Arthroplasty, knee, condyle and plateau; medial OR lateral compartment

 

6.What is hinge arthroplasty of knee ?

The Walldius type procedure, also known as Walldius hinge arthroplasty, is a knee replacement surgery that utilizes a hinged prosthesis, specifically designed for severely damaged knees where standard implants may be inadequate, such as in cases of severe joint instability or significant bone loss.

CPT Code  27445 : Arthroplasty, knee, hinge prosthesis (eg, Walldius type)

 

7.Do we need to code graft placement separately in revision of total knee arthroplasty?

No, it is inclusive

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8.What are the difference between repair and reconstruction of collateral ligament or any ligament? 

Repair: This is a procedure aimed at restoring the ligament's integrity by stitching it back together, typically when the ligament is not completely torn or the tear is in a location that can be repaired directly. It's more of a direct suturing of the injured ligament back to its original position.

Technique used in repair:The surgeon reattaches or sutures the torn ends of the ligament together. The goal is to preserve the original ligament and restore its natural structure

 

Reconstruction: In cases where the ligament is severely torn or if the tissue is too damaged to repair, reconstruction involves using graft tissue (often from the patient’s own body or a donor) to create a new ligament. This new ligament takes over the function of the damaged one.

Technique used in reconstruction : The damaged ligament is removed, and a graft (from the patient's own tendon or another source) is used to rebuild the ligament. The graft is then anchored to the bones, often using screws or other fixation devices.

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CPT Code 27427 : Ligamentous reconstruction (augmentation), knee; extra-articular

CPT Code 27428 : Ligamentous reconstruction (augmentation), knee; intra-articular (open)

CPT Code 27429 : Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular

 

What is revision arthroplasty of knee ?★

Revision arthroplasty is a procedure in which the provider removes a previously implanted artificial knee joint component, or prosthesis, and replaces it with a new prosthesis.

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CPT 27486 : Revision of total knee arthroplasty, with or without allograft; 1 component

CPT 27487: Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component

CPT 27488: Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee