Using the techniques described in this chapter, carefully read through the case study and determine the most accurate ICD$-10-$PCS code$($s$).$Patient: Grayson CarlyleDate: $15$ May $2022$MRN: C$18-54662517$Surgeon: Annalissa Brubaker, MDPRE$-$OPERATIVE: gonarthrosis deformans: four ipsilateral periprosthetic fracturesHPI: A $43-$year$-$old otherwise healthy male patlent with a diagnosis of osteoarthrosis was admitted in $2017$ for elective left$-$knee arthroplasty. He had a history of three nonsignificant knee traumas, and an arthrotomy with synovectomy had been performed on the left knee due to synovitis In $2018.$ His physical examination at admission showed severe Insufficiency of the medial collateral ligament and rotational instability of the left knee joint. Other joints showed no abnormal findings.X$-$ray revealed gonarthrosis deformans stage Il with $5\backslash$deg varus angulation. The patlent underwent total arthroplasty $($Allopro NPK$,$ Switzerland$)$ of the left knee on March $4,2017.$ Postoperative X$-$ray revealed good alignment of the prosthesis; both components were centered in the midline of the joint, and overall knee alignment was $8*$ In valgus.Two $1-$g prophylactic doses of the antiblotic cefuroxime were administered perioperatively. The patient developed a fever on the third postoperative day, and the same antiblotic was administered Intravenously $(750$ mg three times a day, postoperative days $3-10).$The patlent was discharged in good general condition on March $18,2017,$ and he had no medical problems during the outpatient follow$-$up perlod.A year later, on May $26,2018,$ the patient fell at home and was admitted to the hospital with a supracondylar fracture of the left distal femoral metaphysis $($displacement In flexion and varus$).$ Skeletal traction with $7$ kg was applled primarly, and the patient underwent surgery. The tibial component of the endoprosthesis was loose and was removed, the femoral shaft was fixed with a dynamic condylar screw device, and a revision arthroplasty using a long$-$stem endoprosthesis was done.The patient had no postoperative complications. The outpatient follow$-$up period was uneventful, and after $3$ months, he returned to work.The patient started experiencing pain and swelling In his left knee joint approximately $1$ year after the second surgery. An x$-$ray performed in August $27,2019,$ showed radiolucency around the tibial component, which had also migrated anteroinferiorly. Based on these findings and also on clinical and laboratory data, Infection of the endoprosthesis was diagnosed, and the patlent was admitted for $1-$stage revision arthroplasty. Microblological culture from Joint aspirations showed the presence of Pseudomonas aeruginosa sensitive to Tazocin $($piperacillin sodium and tazobactam sodium$),$ ceftazidime, Imipenem, amikadin, gentamicin, and ciprofloxacin.The patient had surgery on September $1,2019.$ Because the previous femoral supracondylar fracture was consolidated, the DCS fixator and endoprosthesis were removed and revision arthroplasty with long$-$stem rotational endoprosthesis $($Link Endo$-$Model Total Hinge Knee$)$ was performed. The tibial defect was additionally filled with $15-$mm spacer.Microbiological cultures taken during surgery confirmed the dlagnosis of P$.$ aeruginosa Infection. During the hospital stay, antibloties were administered Intravenously according to microbe sensitivity $($antiblogram$)$ and our infection protocol: gentamicin $240$ mg once a day and ciprofloxacin $200$ mg twice a day for the first $5$ postoperative days. Starting on the sixth postoperative day, gentamicin combined with ceftazidime $500$ mg twice a day was administered, and was continued for $9$ days.The patient was discharged home with no complaints. He was prescribed oral rifampicin $300$ mg twice a day for the next $2$ months.Full weight$-$bearing was allowed after $6$ weeks.Three months later, the patlent fell on a slippery street and sustained an axially displaced fracture of proximal metaphysis of tibla and fibula. This time treatment was conservative: closed reduction was achleved and maintalned in a long$-$leg cast. Follow$-$up x$-$ray on December $14,2019,$ showed that bone fragments were still in satisfactory alignment and there was evidence of callus formation. The patient returned to work and his usual activitles In January $2022.$On March $9.2022,$ the patient was admitted to the hospital again because of a spiral dislocated fracture in left femoral distal diaphysis.The femur was shortened and displaced axially In varus position. Skeletal traction $(5$ kg$)$ was applied primarily, and surgery was performed later. Offstripping of femoral perlosteum in both fragments was seen during surgery. Internal fixation of the left femoral bone was achleved with an AO plate and screw. The patlent recovered and was discharged on March $17,2022.$ He was told to limit weight$-$bearing for the next $2\mathrm{.}5$ months and to walk with crutches.Unfortunately the patient didn't follow these Instructions, and the plate broke off the bone in Its distal part due to walking. An open reasteosynthesis $($exchange of screws and repositioning of the plate$)$ was performed this moming $($May $15,2022).$