Client: 59 y/o commercial truck driver.
PMH: chronic pain, lumbar radiculopathy, cervical radiculitis, left hip pain (onset 12/02/2022), sacroiliitis, back muscle spasm - managed on long-term opioid therapy (tramadol).
Prior injections:
Left Hip (5/4/23, 10/4/23)
Theory per client: “Pain Management doctor is to blame. There was enough evidence to show that something had to be done operationally. Client complied with everything the doctor said. He changed his insurance; he went to all visits. Yet, the doctor did not send him out to a specialist surgeon (ultimately, he was referred to ortho surgeon 10 months after treatment). The doctor just did more MRIs and injections. If this had been done when the issue first started, he would not be in the physical condition and the financial crisis that he is in. Client thinks that the injection was a catalyst.”
Pain Management doctor treatment timeline:
03/06/2024 Left hip pain – Aspiration negative for blood. Steroid injection left hip.
05/03/2024 Left hip pain 9/10. Referral to Sports Medicine ordered. MRI pending.
06/17/2024 MRI. Severe osteoarthritis w/ flattening of the superior left femoral head. Left hip joint effusion with synovitis. Moderate right hip osteoarthrosis.
07/01/2024 Left hip pain 10/10. Orthopedic Referral ordered.
09/10/2024 Steroid injection left hip.
10/18/2024 CT left hip. "Markedly abnormal left hip with chronic changes and a large joint effusion as described above. A septic hip cannot be ruled out by this exam."
11/12/2024 Right hip pain. First right hip injection. (Supposedly hospitalized the next day for infection in the left hip d/t spread from right hip, but no records of same.)
11/27/2024 B/L hip pain. Started hydrocodone.
12/10/2024 Neurosurgery spine consultation for lumbar/cervical stenosis and osteonecrosis of hip.
01/02/2025 Orthopedic Surgery evaluation. Diagnosed with bilateral primary osteoarthritis of hip and left hip pain.
01/10/2025 Ascension. Diagnosed with DJD of multiple joints.
01/23/2025 Left hip aspiration was positive and is likely chronic osteomyelitis. Right hip aspiration was negative.
01/27/2025 Right hip replacement for primary osteoarthritis of right hip. Robotic Assisted Makoplasty, posterior approach.
02/06/2025 Left total hip for primary osteoarthritis of left hip. Robotic Assisted Makoplasty, posterior approach with antibiotic spacer.
02/19/2025 On antibiotics for post-surgical infection.
03/25/2025 Left hip joint aspiration.
04/26/2025 Left total hip arthroplasty revision for suspected left hip implant infection.
09/25/2025 Orthopedic surgeon referral for hip joint prosthesis.
10/27/2025 Right Total hip Revision – Conversion from Prostalac antibiotic spacer to permanent hip prosthesis.
02/10/2026 Return to work.
Pain Management doctor continued intra-articular steroid injections into a severely degenerative hip with known effusion and synovitis, without adequately excluding infection, thereby increasing the risk of septic arthritis, and contributing to the patient’s subsequent destructive joint process requiring staged arthroplasty and revision for infection. Concern that the injection increased risk and contributed to progression of septic/destructive process. Case concerns: Client appears to have already had end-stage OA so he likely needed THA regardless. There was not an infection not proven immediately post-injection.
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No questions yet!
Do you believe there might have been medical error?
It seems that the Pain physician who did the hip injection was doing it for the benefit of the patient. The patient seemed to get better from that initial injection and or requested another injection to be done two months later. It also seems that the pain management physician requested another sports medicine physician to look at the hip as well as obtaining MRI at the appropriate time, as it seems perhaps at that time the hip pain persisted. I don’t think there was a delay in treatment and/or referral to another orthopedic surgeon. Pain management physicians do the best with what they have, so although there may have been an effusion, it could have been seen on an ultrasound guided injection. An ultrasound guided injection is the gold standard when injecting. It’s difficult to determine if they did this under ultrasound guidance
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
This patient may have already had an underlying issue with being more susceptible to infections. I don’t think that the steroid injection that the physician did illicit in a septic response, especially as we don’t have the medical records for that. I think the causation is somewhat weaker here.
What makes you a good expert for this case?
I am a double board certified anesthesiologist and pain management physician. I am the program Director for the pain management fellowship program at my institution. I see a large variety of different patients in my practice as an outpatient pain provider. I take care of many patients with hip pain. I perform various types of injections, including hip injections
How often do you encounter cases similar to this one in your practice?
Often. Not necessarily with the infection, but with hip osteoarthritis.
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