Orthopedic Surgeon Refuses to Believe Colleagues and Causes Severe Injury to Hip and Knee
The following excerpt from a Notice of Intent to File Claim, or more commonly called, “Notice of Intent to Sue,” is a recent case that the litigators at Erlich, Rosen, Bartnick & Cook P.C., have begun on behalf of one of our clients. If you wish to discuss a medical malpractice claim please contact ERBC at either www.ERBClaw.com or 1-877-453-2840 for a free consultation.
Factual Basis for Claim
Plaintiff, age 33, was experiencing hip pain during heavy physical activity associated with being involved in tri-athlete competitions. She was born with some femoral antiversion and external rotation of her right lower extremity. Plaintiff consulted with an orthopedic surgeon who determined that she needed both a inter trochanteric de-rotation osteotomy of her right hip as well as an arthrotomy with tibial tubercle medialization and open lateral release and osteo chondrial autograft transfer system to the under surface of the patella of her right knee at the same time.
Plaintiff was convinced by Defendant doctor that she needed both the hip and knee surgery performed to alleviate her pain complaints. Defendant not only convinced claimant that she needed both hip and knee surgery, but also that the two surgeries should be performed during the same procedure. Prior to performing such a surgery, it is necessary to take the proper preoperative imaging studies and 3-dimensional measurements to properly determine the patient’s preoperative status and determine the post operative positioning goals. This is achieved by ordering bilateral lower extremity CT rotational studies. Without taking the necessary presurgical measurements, it is not possible for the surgeon to properly align the patient’s hip into the desired anatomical position during the surgery itself due to the necessity of first performing an osteotomy to disconnect the hip and allow repositioning. Once the osteotomy has taken place, the surgeon must rely upon the preoperative CT rotational measurements to properly reposition the hip at the correct angle since the osteotomy procedure destroys the point of reference, vis-à-vis the original position of the hip.
The correct preoperative measurements will also allow the surgeon to properly place the hardware utilized to hold the hip back together and avoid failure of the hardware due to excessive force being applied to incorrectly placed hardware and post surgical out of correct anatomical alignment hip placement/rotation.
Defendant orthopod performed Plaintiff’s osteotomy and de-rotation procedure on her right hip without taking the proper preoperative measurements and without doing the necessary calculations to properly realign Plaintiff’s hip in the correct anatomical position. The failure to properly realign Plaintiff’s hip in an anatomically correct position caused stress upon the internal fixation hardware and failure of the procedure. Defendant’s oversimplification vis-à-vis the hip osteotomy and de-rotation directly led to a failure of the procedure in under two weeks.
In addition to the incorrectly performed hip surgery, Defendant orthopedic surgeon also performed knee surgery that was completely unnecessary and resulted in surgically removing Plaintiff’s cartilage from its anatomically correct position to a non anatomically correct position making it abnormally prominent requiring corrective surgery to attempt to place the cartilage back into its original correct position. Plaintiff did not have the requisite pain complaints preoperatively, vis-à-vis her knee, to warrant surgical intervention of the knee. At the very least, the hip surgery should have been tried first to see if that alone would alleviate her pain complaints before any knee surgery was contemplated.
Defendant doctor, while performing the unnecessary knee surgery on Plaintiff’s right knee on January 26, 2009, ill advisedly surgically moved Plaintiff’s cartilage from its correct anatomical position and reattached it in an incorrect anatomical position on Plaintiff’s tibial tubercle causing instability and scar tissue formation.
Following the January 26, 2009 surgeries Plaintiff was an inpatient until February 1, 2009. Upon discharge home, Plaintiff developed a small bowel obstruction and was admitted to another hospital from February 6, 2009 – February 8, 2009. Abdominal x-rays taken on February 6, 2009 at this hospital were read by the radiologist as showing an abnormal lucency along the fixating hardware with angulation of the right hip suggesting re-fracture of the right hip with possible infection.
An orthopedic consult was performed at this hospital by an orthopedic surgeon who reviewed the films and interpreted them as showing the hardware coming out and he wanted to take Plaintiff back to surgery to fix the problem. Instead, Defendant was contacted and Plaintiff was transferred back to the original Defendant Hospital on February 8, 2009. Repeat x-rays were done on February 8, 2009 at the Defendant Hospital. The 2/8/09 hip x-rays were interpreted by a resident radiologist and verified by an attending physician radiologist. The resident’s interpretation in pertinent part was:
“Two view of the right hip was obtained compared to prior study January 29, 2009. Stable appearance of the metallic plate with multiple transfixing screws through the ostomy at the right proximal femur is noted. Stable post operative changes. No acute fracture or dislocation.”
Defendant orthopod also misinterpreted the 2/8/09 hip x-rays as being normal and rather than take Plaintiff back into surgery to correct her failed hip hardware condition, he instead ordered her into physical therapy. Plaintiff entered rehabilitation on February 10, 2009 and underwent physical therapy with her failed hip hardware until she received a second opinion on February 14, 2009 by a subsequent treating orthopedic surgeon.
The subsequent treating orthopedic surgeon saw Plaintiff on February 14, 2009, took one look at the February 8, 2009 x-rays, and immediately diagnosed the failed hardware. He ordered physical therapy to immediately stop and scheduled Plaintiff for reparative hip surgery. Plaintiff was transferred back to the treating hospital on February 17, 2009 where her new surgeon performed an exploration of her right hip with removal of the hardware, an open reduction, and external fixation with compression of her right hip. Since Defendant orthopod negligently failed to take the appropriate preoperative CT rotational measurements of Plaintiff’s original hip position, her new surgeon was left to make an educated guess as to the proper anatomical position that would fix Plaintiff’s hip deformity. His surgery was successful in fixing the failed hardware situation, but the final placement of Plaintiff’s hip ended up nearly in the same position anatomically as she was prior to her first surgery without the desired correction, that a properly planned and executed corrective surgery should have achieved due to the lack of a proper preoperative work up by Defendant orthopod before the original January 26, 2009 surgery.
In addition to Plaintiff’s hip surgery failure and lack of desired result, even with subsequent reparative surgery, she also suffered greatly from Defendant’s unnecessary and ill-advised knee surgery. Her new surgeon had to perform corrective knee surgery upon Plaintiff on July 1, 2009 where he attempted to put the Plaintiff’s cartilage back into the proper anatomical positioning where it originally was before Defendant surgically moved it out of anatomical alignment.
Plaintiff is currently recovering from her recent corrective knee surgery and her final outcome is still unknown. Plaintiff will suffer arthritic changes due to her two surgeries and also more likely than not will need at least one knee replacement surgery in the future.
As a direct result of Defendant’s oversimplifying the proposed corrective procedures to the Plaintiff, and his failure to inform her that only the hip surgery was necessary, as well as his failure to inform Plaintiff that he did not have the technical skill nor training experience necessary to properly perform such a difficult operation, Plaintiff was not properly informed as to both the hip and the knee surgeries performed upon her on January 26, 2009 and therefore could not, and did not, give informed consent to either of the two surgeries performed by Defendant on that date Furthermore, as a result of Defendant’s negligence and failure to appreciate the fact that Plaintiff’s pain complaints were emanating solely from her hip region, and that a surgical correction in the Plaintiff’s hip region would require a very difficult and technically challenging procedure, Defendant negligently proceeded with an oversimplified surgical approach to the Plaintiff’s hip without proper preoperative workup, measurements, and imaging studies, and also proceeded at the same time with an unnecessary surgery on her right knee.
Defendant’s failure to properly evaluate Plaintiff’s hip preoperatively, by failing to take bilateral lower extremity CT rotational studies, and his oversimplification of the process, resulted in both an incorrectly aligned post operative hip de-rotation osteotomy as well as resulted in the inability to subsequently correct his mistake due to a lack of information and measurements concerning Plaintiff’s preoperative hip positioning. The post operative incorrect positioning of Plaintiff’s hip osteotomy led to internal fixation hardware failure within ten days of the original surgery due to the excessive force, leverage and cantilevering effect subjected to the incorrectly aligned hip and the hardware which was holding the osteotomy in place.
The loosening of the hardware in Plaintiff’s hip resulted in extreme pain and discomfort and was properly diagnosed on x-ray findings on 2/6/09. Defendant was properly informed by the physicians at the subsequent hospital that Plaintiffs’ hardware had failed but he negligently ignored this information. Defendant instead ordered hip x-rays to be taken at the Defendant Hospital on 2/8/09 which were negligently interpreted and reported out by the resident radiologist to Defendant as showing stable hardware rather than the correct interpretation of showing failed and loosened fixation hardware as properly diagnosed two days earlier. The incorrect diagnosis and opinion of the resident radiologist, coupled with Defendant’s negligent interpretation of the 2/6/09 and 2/8/09 x-ray films vis-à-vis his hardware placement of Plaintiff’s hip fixation screws and plate, and his negligent ignoring of the opinions of his colleagues resulted in Defendant negligently ordering Plaintiff into painful physical rehabilitation for her hip with her failed hardware.
Because of Defendant’s negligence in ordering Plaintiff to participate in physical rehabilitation with a failed hardware condition, she suffered extreme pain and suffering and further damage to her hip anatomy which resulted in making the corrective surgery on 2/17/09 more difficult due to the damage caused by performing physical rehabilitation on a hip with failed hardware.
The loosening of the hip osteotomy hardware resulted in the need for corrective surgery. Defendant’s negligent failure to properly measure Plaintiff’s preoperative hip positioning led to the inability of the subsequent orthopedic surgeon to correctly align the Plaintiff’s hip in proper anatomical alignment vis-à-vis her original condition while performing the hardware corrective surgery. This resulted in the Plaintiff’s hip now having healed very close to its original mal-positioning without any possibility of any future corrective surgery due to the presence of both surgical scar tissue and bony scarring of the hip osteotomy and the extreme difficulty these conditions would present in successfully performing a third hip operation.
Defendant’s negligent decision to also perform knee surgery on January 26, 2009 resulted in the Plaintiff having to undergo an unnecessary procedure on that date. Furthermore, Defendant negligently performed the unnecessary knee procedure when he surgically repositioned Plaintiff’s knee cartilage out of proper anatomic alignment and into an incorrect placement of her knee cartilage. This resulted in the need for corrective knee surgery to be performed in an attempt to move her cartilage back into her original proper position. Because of Defendant’s negligence, vis-à-vis Plaintiff’s right knee, she has had to undergo two surgeries on her right knee in the last six months, which will result in scarring and arthritic changes and more likely than not will cause permanent damage and the future need for a total knee replacement and/or other surgical procedures on her right knee.
