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Too long to run

01 January 2008

Mr C, a 45-year-old PE teacher, attended the outpatient clinic to see Mr V, consultant orthopaedic surgeon. Mr C was also a keen marathon runner, but due to an increasingly painful right hip he had found running more difficult. X-rays confirmed advanced degenerative changes on his right hip joint. Mr V initially suggested a trial of conservative treatment, including modification of physical activities and analgesia. Mr C had done some research on the internet regarding “the Birmingham hip”, which he understood would give him several years of running. Mr V explained the potential risks of such a procedure, but Mr C was keen on the surgery and Mr V agreed to carry out the operation.

Mr V performed a hip resurfacing arthroplasty. The procedure was uneventful, but unexpectedly there was a leg length discrepancy (1.9cm) as a result. In the immediate postoperative period and during the first outpatient follow up, Mr V regarded this as an acceptable result. However, Mr C was unable to carry on with his running training and eventually could not manage all aspects of his job as a PE teacher. Mr C brought a claim against Mr V.

Expert opinion

An expert orthopaedic surgeon supported Mr V’s performance of the surgical procedure. The standards of Mr C’s records were generally good. However, there was a disagreement with the expert commissioned by Mr C, who maintained that Mr V told Mr C that after the operation he would be able to carry on with his marathon running. Mr V denied giving such information. After a meeting of the two experts, the claim was discontinued, with each side bearing their own costs.

Learning points

  • With an increasing number of medical websites, it is common for patients to attend an outpatient clinic with some information about their condition. The information on the internet is unfiltered, can be inadequate or even completely inaccurate. Frequently there are commercial interests that may not be apparent initially. It is the doctor’s obligation to clarify the patient’s expectations, and adjust the information they bring to their own practices.
  • An integral part of obtaining informed consent prior to a surgical procedure is the discussion of the potential risks during surgery (such as leg length discrepancy) and, if pertinent, during the rehabilitation period and even long term effects (inability to run long distances). Patients must be given sufficient information about the treatment, in a way that they can understand, in order for them to make an informed decision. There are good patient information leaflets on hip replacement, for example. A letter to the patient’s GP, copied to the patient, which records details of the discussion, is another useful option.
  • A contemporaneous entry in the clinical notes should be made, stating that valid consent has been obtained, listing the risks and complications discussed with the patient.
  • Where, as in this case, a patient’s occupation or lifestyle might be particularly affected by possible outcomes of the treatment, it would be good practice to explore these specifically with the patient. Again, recording details of these discussions, and their conclusions, in the notes would be good practice.
  • In 2006, 51% of worldwide medical claims were settled, 46% were successfully defended and only 3% went to trial. Of those claims which went to trial, 78% were defended successfully.