On August 29, 2022, Patient underwent a procedure on her knee at Medical Group, performed by Dr. X. Patient had a total right knee replacement surgery 14-years prior to this. The right knee had been causing her pain. She had been assured by Dr. X that the procedure would alleviate her chronic knee pain and improve mobility. However, from the moment she awoke from surgery on 8/29/22, she experienced severe and persistent pain far beyond what had been described as normal.
Over the following weeks, Patient’s condition worsened. Her knee remained swollen, unstable, and she struggled to bear weight. Despite her repeated complaints, Dr. X dismissed her concerns as part of the healing process. At her follow-up, Patient continued to express her discomfort and pain to Dr. X, still nothing was done, she was told it was normal.
On December 15, 2022, unable to bear the pain any longer Patient went to the urgent care at Different Medical Facility, where she was seen by Dr. Y and Dr. Z. Further examination confirmed that the plastic hardware previously used had been a “washout” instead of replacing the old hardware with new hardware. This procedure led to infection, discomfort and agonizing pain. Due to the negligence of Dr. X, Patient had to undergo several surgeries to correct the matter as well as she will have to continue to take antibiotics to fight the infection for the duration of her life.
We want to know:
(1) Did Dr. X and/or his medical staff deviate from the standard of care necessary during the knee surgery ‘washout” on 8/29/2022?
(2) Should Dr. X have explained to Patient that he was going to reuse the plastic hardware from her prior surgery?
(3) Was there an alternative approach instead of the “washout” procedure that could’ve been taken by Dr. X?
(4) Did Dr. X deviate from the standard of care by not informing Patient of the possibility of infection as a post-operative condition that could develop?
(5) Should Dr. X have checked with the distributor of the plastic hardware to ensure it was reusable and if so, how many years would it last?
(6) Did Dr. X and/or his staff deviate from the medical standard of care by releasing Patient from their facilities so soon after a major surgery?
Patient was forced to undergo several painful revision surgeries, which extended her recovery period by another year and left her with permanent mobility limitations
Files:
Q: What was the reason for the first surgery and what was the vendor/manufacturer and model of the knee replacement?
A: —
Do you believe there might have been medical error?
It is unclear from this limited account what the presenting signs and symptoms were in August, and what Dr. X. actually did. If the sole presenting issue was polyethylene wear, then performing a poly liner exchange is not unreasonable. A prosthetic joint infection (PJI) could then occur after that surgery - that is a known potential complication of revision arthroplasty surgery. Without the detailed medical records, we do not know what was going on in August. If the patient did present with signs and symptoms that were concerning for a PJI in August, then a simple washout and liner exchange likely would have been insufficient and potentially grounds for negligence/error.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
There is not enough detail to go on here to establish this with any certainty. But it does seem as though the surgeon was dismissive of the patient's complaints.
What makes you a good expert for this case?
I am a board-certified orthopedic surgeon, a diplomate of the American Board of Orthopedic Surgery, and I have reviewed many cases involving revision surgery and infections of implanted prosthetics.
How often do you encounter cases similar to this one in your practice?
Thankfully not that commonly, however it would be on the order of approximately 1 or 2 per year.
Do you believe there might have been medical error?
There are a lot of details left out of this case. We do not know the reason for revision. Its unclear why the plastic was left in and it is atypical that this is done, but there may be reasons why the plastic was left in based on omitted details for the cause of revision
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Again, there is tremendous amount of details that are not presented in this story. without knowing them, it is difficult to support anything.
What makes you a good expert for this case?
I do a high volume of both primary and revision knee replacement
How often do you encounter cases similar to this one in your practice?
I frequently do revisions of other surgeons. I also have to have clinical decision making for when to revise and the many different pathways.
Do you believe there might have been medical error?
Medical error if procedure truly involved removing the polyethylene liner and then reimplantating the removed liner
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Medical error if procedure truly involved removing the polyethylene liner and then reimplantating the removed liner. This is more so if the patient had a washout which is a procedure for infection.
What makes you a good expert for this case?
Hip and knee replacement surgeon with experience performing revision surgeries to include knee washouts
How often do you encounter cases similar to this one in your practice?
Never encountered a case where the removed polyethylene liner was removed and replanted in a case of a washout…presumably for infection
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