Total hip arthroplasty (THA), commonly known as total hip replacement, is a surgical procedure that alleviates pain and restores function to a damaged hip joint. Healthcare providers document and bill this operation using a standardized identifier from Current Procedural Terminology (CPT). CPT 27130 is the code assigned to total hip replacement, serving as the uniform language for describing the procedure to insurers and for medical record-keeping.
Understanding the Code’s Scope
The CPT code 27130 precisely defines the procedure as “Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without cement.” Arthroplasty refers to the surgical reconstruction or replacement of a joint. This code specifies that the surgery involves replacing both primary components of the hip joint’s ball-and-socket structure.
The two parts replaced are the acetabulum, which is the socket portion in the pelvis, and the proximal femur, which includes the head and upper part of the thigh bone or femoral stem. The code’s inclusion of “with or without cement” indicates that it covers both methods of fixation for the prosthetic components. Cemented fixation uses bone cement to hold the implant in place, while uncemented fixation relies on the bone growing directly onto the porous surface of the implant, a process called osseointegration.
Conditions Requiring Hip Arthroplasty
The decision to proceed with a total hip arthroplasty is made when non-surgical treatments have failed to provide adequate pain relief and improve mobility. The most frequent medical necessity for this procedure is severe degenerative joint disease, primarily Osteoarthritis (OA). This condition involves the wearing away of the slick articular cartilage that covers the ends of the hip bones, leading to painful bone-on-bone friction and stiffness.
Other conditions that severely damage the hip joint also necessitate replacement. Rheumatoid arthritis, an inflammatory autoimmune disease, can erode both the cartilage and the underlying bone, leading to joint deformity. Avascular necrosis (AVN), or osteonecrosis, occurs when the blood supply to the femoral head is interrupted, causing the bone tissue to die and ultimately collapse. Severe traumatic injuries, such as complex hip fractures that compromise the joint’s integrity, may also require a total hip replacement.
The Surgical Procedure
Total hip arthroplasty is performed under general or regional anesthesia. The surgeon begins by making an incision to access the hip joint, with the specific location varying based on the chosen surgical approach, such as the anterior, posterior, or lateral method. The direct anterior approach, for instance, is often referred to as muscle-sparing because it accesses the joint from the front without detaching major muscle groups.
Once the joint is exposed, the surgeon removes the damaged femoral head and shaves the upper end of the femur to prepare the bone for the prosthetic stem. The hollowed-out canal of the femur receives the metal femoral stem, which is then topped with a prosthetic ball, often made of ceramic or metal. Simultaneously, the damaged cartilage and bone within the acetabulum, the hip socket, are removed through a process called reaming.
A metal shell, known as the acetabular cup, is then secured into the prepared socket. A liner, typically made of highly cross-linked polyethylene, is placed inside the cup to serve as the new bearing surface. This liner articulates with the prosthetic ball, mimicking the natural ball-and-socket action of a healthy hip joint. The surgeon carefully positions the components to ensure proper joint stability and range of motion before closing the surgical wound.
Recovery and Rehabilitation
The recovery process begins immediately after the surgery, focusing on pain management and early mobilization to prevent complications like blood clots. Many patients are encouraged to stand and take their first steps with assistance from a physical therapist within 24 hours of the operation. The typical hospital stay is relatively short, often ranging from one to three days, depending on the patient’s overall health and the specific surgical approach used.
Physical therapy (PT) is a central and ongoing part of rehabilitation, starting with gentle exercises to restore strength and range of motion. Initial short-term goals include regaining independence in basic daily movements and learning any necessary hip precautions to avoid dislocation of the new joint. Patients commonly transition from using a walker or crutches to a cane within the first few weeks, with significant improvement in mobility seen by the six-week mark.
Full recovery from the procedure is a longer process, often taking six to twelve months before a patient can return to all normal activities, including low-impact sports. The long-term outlook for total hip arthroplasty is excellent, with modern prosthetic implants lasting for 15 to 20 years or more. Consistent adherence to the physical therapy program is necessary for achieving the best functional outcome.