Total Hip Arthroplasty

Total hip arthroplasty is covered for femoral neck/acetabular fractures, non‑union/malunion or failure of prior hip surgery, revisions for implant loosening/failure/dislocation/infection/periprosthetic fracture/leg‑length inequality/bone loss/bearing wear/adverse local tissue reaction, advanced radiographically proven joint disease (including avascular necrosis), pain or functional disability unresponsive to conservative care, and joint malignancy when appropriate. Coverage requires documentation of imaging evidence and clinical pain/functional impairment, a history of unsuccessful conservative therapy or a documented rationale why it’s inappropriate, and for revisions a specific documented reason; it is not medically necessary with active local/systemic infection, active UTI or dental infection, rapidly progressive neurologic disease (except displaced femoral neck fracture), and certain relative contraindications (neurotrophic arthritis, rapidly bone‑destroying processes, insufficient abductor musculature) unless clearly justified in the record.