On 1/26/24, client had a Left TKA with left knee MAKOplasty at HCA Ocala. On 12/10/24, she had a left total knee revision, with arthrotomy and MUA at HCA Ocala. On 2/4/25, a 3rd surgery was done at HCA Ocala - foreign object left in her knee after radiographs from the clinic revealed a piece of drain tubing in the posterior aspect of the knee. Fluoroscopy was used to visualize the retained foreign body which was involved in scar tissue posteriorly.
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Q: were preoperative labortory studies performed, to include cbc, esr and crp?
A: —
Do you believe there might have been medical error?
Retention of a surgical foreign body (drain tubing) after a total knee arthroplasty and subsequent revision is widely recognized as a preventable event and generally considered a “never event.” It reflects a breakdown in standard operative protocols, most notably surgical counts, wound inspection, and/or device management prior to closure or removal following surgery. Even accounting for complex revision surgery and scar tissue, retained tubing is not an expected risk when appropriate safeguards are followed, making this a clear deviation from accepted surgical practice.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The retained drain fragment directly necessitated a third surgical procedure for removal, as confirmed by imaging. This resulted in additional anesthesia exposure, operative risk, pain, recovery time, and likely exacerbation of scar formation and stiffness. While prior surgeries contributed to baseline morbidity, the need for reoperation and its associated harms are directly attributable to the retained foreign body, establishing a clear causal link.
What makes you a good expert for this case?
I am a board-certified, fellowship-trained orthopedic surgeon. I have served as an expert witness in multiple cases with experience in review, deposition, and in-court testimony work, for both plaintiffs and defendants.
How often do you encounter cases similar to this one in your practice?
Thankfully I do not encounter retained foreign object cases frequently in my practice. However, this is the type of case I might be referred occasionally as a second opinion.
Do you believe there might have been medical error?
The removed item was a piece of drain tubing. If a drain was used during the index surgery or the revision surgery, the drain should have been marked by cutting between the drain holes to make sure when removed the entire drain tubing was removed. The medical error is upon removing the drain. The tubing should also have been visualized on subsequent radiographs prior to the fluoro which was used for removal.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
More than likely the individual was experiencing pain and scar tissue formation as a reaction to the foreign body (tubing) which then necessitated further surgery for removal of the foreign body and scar tissue.
What makes you a good expert for this case?
I specialize in revision total joints and have been practicing post fellowship in Adult reconstruction for 26 years. I have extensive experience in revision total knee arthroplasties, arthrofibrosis and evaluation of complex total knee arthroplasties.
How often do you encounter cases similar to this one in your practice?
On a regular basis, since approximately 50 % of my total joint arthroplasties are revision surgical procedures.
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