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Complications happen

01 May 2004

Mr K, a manager in his sixties, saw an orthopaedic consultant, Mr C, about his painful right hip and thigh. Mr C suspected avascular necrosis of the femoral head as the cause of Mr K’s symptoms. An MRI scan confirmed this diagnosis.

Mr C recommended a right total-hip replacement, which he carried out without any intra-operative complications. Unfortunately, Mr K suffered a pulmonary embolus, requiring his transfer to ITU under the care of a specialist physician.

He was treated with heparin and made a good recovery, but it seemed likely that the heparin had caused a haematoma to form at the operation site, leading to wound swelling and symptoms of sciatic-nerve dysfunction.

Mr C twice explored the wound and evacuated a haematoma,  demonstrating the integrity of the sciatic nerve during this procedure. Mr C reviewed Mr K’s condition regularly; he also sought a second opinion to ensure he wasn’t missing something, but was reassured that this was not the case.

Mr K brought an action claiming that negligence on the part of Mr C had left him with persisting symptoms of sciatic nerve damage, with pain and parasthesiae affecting his right lower limb, along with foot drop and chronic depression secondary to the pain.

Expert opinion

Experts advising Mr K suggested that the nerve damage could have been caused by heat from bone cement used in the procedure, but Mr C pointed out that he had only used cement in fixing the femoral component of the prosthesis, not the acetabulum, making this explanation unlikely.

The expert we consulted thought it far more likely that the sciatic nerve had suffered pressure-damage from a haematoma, as an unintended consequence of Mr K’s heparinisation – a treatment that had been necessary for his wellbeing.His report was very supportive of Mr C’s standard of care, ‘ … it does not appear that anything done by the surgeon at the time of hip replacement was directly responsible for the sciatic nerve injury … As to whether Mr C’s treatment was of an acceptable standard, from the documentation at hand, I cannot find any fault.’

On this basis we resolved to defend the case and deny liability on Mr C’s behalf. Soon after we issued a rebuttal of the claim, Mr K discontinued the action.

Learning point

Complications of treatment are not, in themselves, evidence of negligence; they are just unintended consequences that can occur, even when the clinician is exercising great skill and care. Unless the claimant can establish a lapse in the standard of care and causally link it to negligence or failure to warn of the adverse outcome, he does not have a viable case.