Total Knee Arthroplasty

Total knee arthroplasty (and indicated revisions) is covered for advanced joint disease or significant pain/functional loss from arthritis, trauma, osteonecrosis, malignancy, fractures, failed osteotomy or unicompartmental replacement, and for revision indications (loosening, fracture/mechanical failure, infection, periprosthetic bone loss, wear, malalignment, stiffness, instability, extensor mechanism problems); it is not medically necessary with active knee/systemic infection, active urinary/dental/skin infection, rapidly progressive neurological disease, or other listed contraindications unless clearly justified. Key requirements: documented unsuccessful conservative therapy (or clear rationale if inappropriate), radiographic/MRI/CT evidence of advanced disease, documentation of absence/resolution of infections, documented reason for revisions, use of FDA class II/III implants, and explicit medical-record justification when relative contraindications exist.