The most common problem in orthopaedic medicine is failure to diagnose, manage and treat a fracture. Please see our expertise in Accident and Emergency Medicine.

Some orthopaedic surgeons have a specialism and this then creates further issues in relation to substandard treatment by a hip surgeon.

Case Report

T v The Royal Liverpool and Broadgreen University Hospital NHS Trust

T started to experience pain and instability affecting his left knee in or around September 1996 at the age of forty four.   He was referred by his G.P. to the Orthopaedic Out-Patient Department at Broadgreen where he was assigned an appointment with a consultant orthopaedic surgeon.  In the referral letter, the G.P. noted a history of giving way and cracking of the left knee.  He stated that the radiograph of the knee had been reported as normal.

The consultant orthopaedic surgeon saw the Claimant on the 10th June 1997.  He too obtained a history of problems with the left knee and noted that there was not any problems with his hips, back or opposite knee.  He made a diagnosis of a lateral meniscal tear of loose body and listed him for a day case arthroscopy of the left knee.

The arthroscopy took place on the 12th September 1997.  The consultant orthopaedic surgeon performed the procedure.  In the detailed operation notes he recorded that there was a degenerative tear of the left medial meniscus and some degenerative changes affecting the medial side of the joint.   The tear was trimmed and the chrondrel cartilage debrided.

The Claimant appeared to have enjoyed a brief respite of his knee symptoms for some eleven weeks after the knee operation before he was consulting the consultant orthopaedic surgeon again this time on a private basis.

On this occasion the consultant orthopaedic surgeon noted a history of pain radiating through the inner aspect of his thigh and groin.  On examination the orthopaedic surgeon noted that external rotation and full flexion of the left hip was painful.  In his letter the G.P. expressed concern about the left groin and thigh pain and told the Claimant to keep his appointment for later that month and the orthopaedic surgeon said he would ensure that radiographs of the pelvis as well as the knees were made at that time.

The Claimant returned to the Broadgreen Clinic on the 23rd June 1998.  The orthopaedic surgeon reported to the G.P. that he was complaining of left groin pain and further problems with his left knee.  He states that he was arranging a further arthroscopy of the knee.  At the same time he was arranging for the Claimant to have a radiograph of his pelvis.

The records show that the radiograph was taken on the same day as the Claimant visited the consultant orthopaedic surgeon's clinic.

The radiograph is reported as showing advanced osteoarthritic changes in the left hip with a marked loss superior joint space and subarticular eburnation and minor arthritic changes in the right hip.

There was no evidence that the consultant orthopaedic surgeon saw either the pelvic radiograph or the report prior to the further arthroscopy.

On the 27th July 1998 the consultant orthopaedic surgeon carried out a second arthroscopy on the Claimant and he reported further degenerative changes.

In follow up clinic in November 1998 the examining senior house officer stated that the Claimant had a full range of movement of the left knee but was complaining of pain in the knee which shot up the side.  He injected steroids into the knee joint at this time.

Between November 1998 and July 1999 the Claimant underwent injections but without any relief of his symptoms.  There is no evidence that the Claimant's hips were examined during any of the appointments.

In October 1999 a knee brace was recommended and in May 2000 a consultant orthopaedic surgeon again saw the Claimant and recommended him for a unicompartmental knee replacement.

In June 2001 the consultant orthopaedic surgeon spoke to a colleague at North Manchester Hospital and asked him to take over the Claimant's care.

The consultant at Manchester Hospital agreed and saw the Claimant on the 3rd September 2001.

He performed radiographs of the hips and they were said to show severe osteoarthritis of both hips and radiographs of the knees were said to be normal.

In April 2002 the Claimant underwent a double hip replacement.

A independent medical report was obtained which confirmed that the defendant trust was negligent in that they failed to follow up the report of the pelvic radiograph obtained of the Claimant on the 23rd June 1998 and further failure to take these findings in to consideration in light of the Claimant's ongoing symptomology.

Liability was admitted by the defendant trust and the case settled for £64,000 to reflect loss of earnings, care and pain and suffering.

Notes

John Pickering and Partners LLP

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