Total Hip Arthroplasty

Total hip arthroplasty is considered medically necessary for advanced hip joint disease with corroborating imaging and pain or functional disability not controlled by appropriate conservative therapy, and for specific conditions such as avascular necrosis, fractures, malignancy involving pelvic/proximal femur, or when revision is indicated for implant failure, infection, fracture, or progressive bone loss. Absolute contraindications include active joint or systemic infection and active local infections in the surgical field, while several relative contraindications (e.g., abductor insufficiency, rapidly destructive bone processes, neurotrophic arthritis) require documented rationale if surgery is performed. Documentation must include imaging evidence, records of prior conservative treatments or rationale for not using them, and specific reasons for revision when applicable; additional billing/coding documentation is referenced in an associated article.

"Advanced hip joint disease demonstrated by radiographic evidence (or MRI/CT when radiographs inadequate) showing findings such as subchondral cysts, subchondral sclerosis, periarticular osteophytes..."