Surgical Injury to Artery during Knee Replacement Results in Amputation

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 1-800-595-0506 for a free consultation.

Factual Basis for Claim

On September 19, 2007, Plaintiff, age 72, had elective left total knee replacement. During the surgery Defendant orthopedic surgeon injured the popliteal artery and/or vein. He failed to recognize this, and failed to repair the injury. While Plaintiff was still in the hospital following the surgery, she quickly developed signs and symptoms indicative of a lack of blood flow to her leg. This problem was not timely investigated, diagnosed or treated. The appropriate studies were not timely ordered and a vascular consult was not timely obtained. As a direct result of this medical negligence, Plaintiff ultimately was forced to have an amputation of her left leg, below the knee.

After her total knee replacement surgery, Plaintiff was transported from the OR via stretcher at approximately 10:45 a.m. The nursing note on the floor at approximately 3:00 p.m. indicates that the patient was crying with pain. She complained of feeling pressure on her knee. A nurse reported that her pedal pulse was weak. Defendant surgeon was informed of these problems with his patient but nothing was done. At 9:45 p.m., on September 19, 2007, the nursing notes indicate that Plaintiff was still reporting pain from her hip to her left ankle. The record also indicates that she had no sensation �??below half of left foot�??. Her pedal pulse was still noted to be weak, and the anesthetist on call was informed of the patient�??s status. No orders were obtained, but the nurse was instructed to watch the patient overnight for any weakness, and to call in the morning if there were changes present. On September 19, 2007, a nursing note at 10:50 p.m. states that the patient still had no sensation below half of her left foot, and there was pain from the hip to the ankle. Defendant surgeon was informed of all of Plaintiff�??s post operative problems but still no orders were given. The nurse further noted that the pedal pulse was �??still weak�??. There was nothing documented that reflected a comparison of pulses of her left leg with her non-operated upon right leg.

The first postoperative physician note was on September 20. This note makes no reference to the weak pedal pulse or the lack of sensation. In fact the note discusses getting the Plaintiff ready for discharge home rather than address her medical problems with her left leg.

Physical therapy treatment was scheduled for Plaintiff on September 21. Her pain level that morning was 9/10. By 4 P.M. that day the physical therapy note indicates that the patient reported 10/10 pain. A nurse was informed. The note further states �??patient reports she has not been able to dorsiflex left ankle since surgery.�??

On September 22, 2007, there are no written nursing progress notes for the entire day provided by Defendant Hospital. There is a physical therapy note at 9:50 in the morning. This note indicates that a staff member spoke with nursing regarding the patient�??s left lower extremity excessive warmth and tenderness. She complained of 10/10 pain.

There is a physical therapy note at 11:30 a.m. on September 23, 2007. The note indicates the Plaintiff was complaining of such severe pain that the pain could not be rated. A nursing note on September 23rd at 6:00 p.m. indicates that Plaintiff was complaining of cramping pain in the left leg and the left foot was cold to touch. This note also indicates �??foot drop noted�??. The note indicates that no flexion of the foot was possible. Blisters and bruises were noted on the left lower extremity.

A nursing note at 8:45 a.m. on September 24th indicates edema of 2+ to the left lower extremity. The note further states that the left foot was cold, �??cyanotic to sole of foot, no pedal pulse and no posterior tibial pulse palpated. No audible pulse with Doppler�??. The record further states, �??Doctor notified. Doctor aware of 81% pulse ox. No sensation to left foot. Unable to move leg from thigh down�??.

There is an untimed and undated consultation in the records by Defendant vascular surgeon. It appears that it was dictated on September 24, 2007 at 1:46 p.m. The consultation indicates that the vascular surgeon was asked to see the patient because of the recent development of increasingly severe calf pain, blistering, and a �??cold left foot�??. A venous Doppler had been done, which demonstrated no evidence of deep vein thrombosis. However, a recent arterial duplex was done, and this demonstrated limited flow to the left foot, and a possible arteriovenous fistula. On physical exam, the vascular surgeon found pulses throughout the left leg and a staple line across the midline of the patella. The calf was noted to be tense and swollen. There was blistering in the calf. The left foot was blanched and there was foot drop at the ankle. His impression was lower extremity ischemia either due to compartment syndrome or arterial compression syndrome. Testing revealed the presence of an arteriovenous fistula (AVF) and no arterial flow extending beyond the knee.

The vascular surgeon performed surgery on September 24, 2007, at 7: 30 p.m. in an attempt to salvage the limb. The preoperative diagnosis was an ischemic left lower extremity secondary to an arteriovenous popliteal fistula. A large arteriovenous fistula and a large pseudoaneurysm was found during the surgery. (This finding can only be explained by the fact that a direct injury to the popliteal artery and vein must have occurred at the time of the knee replacement surgery.)

Despite the surgery of September 24th, Plaintiff experienced further pedal ischemia and a recurrent ischemic left foot. She required another surgery by the vascular surgeon on September 25, 2007. The dorsal pedal pulse was absent, as well as the posterior tibial pulse. During the surgery, thrombus and debris were extracted through a Fogarty catheter. At the conclusion of the procedure, flow was allegedly established and a strong palpable pulse was obtained in the posterior tibial artery.

Following the surgery on September 25, 2007, adequate blood flow to sustain the lower limb and foot could not be maintained. Unfortunately, the ischemia could not be reversed due to the fact that the vascular surgery intervention in this case was done too late. As a result, Plaintiff eventually required a below the knee amputation, which was performed on October 1, 2007. She was ultimately discharged from the hospital on October 13, 2007. There were significant delays in Plaintiff�??s treatment that contributed to the loss of her leg. Plaintiff underwent left total knee arthroplasty (replacement), on September 19, 2007, and had immediate post operative complaints related to lack of blood flow but a vascular consult was not completed until September 24, 2007; a five day delay which cost her the loss of her left leg from the knee down in October of 2007 following her elective total knee replacement surgery.

Plaintiff suffered severe injuries and endured significant pain and suffering as a result of the medical negligence committed in September of 2007. Plaintiff�??s medical problems stemming from these acts of malpractice did not end there and in fact worsened over time. She required above the knee amputation of her left leg in February 2009 as a result of ongoing problems with infection and loss of viable tissue and bone. Plaintiff would never have been subjected to this second amputation surgery if her below the knee amputation had been prevented in the first place.

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