Alleged Improper Performance of Hip Surgery

Background

A 69-year-old male patient underwent revision surgery of a previous hip replacement. Following the surgery, the patient experienced subluxations and severe pain over the next three months. Despite reporting these issues to consultant A during outpatient appointments, no further investigations were undertaken and the patient was prescribed pain medication and physiotherapy.

Incident

The patient remained unhappy with the surgical outcome and ultimately sought a second opinion from consultant B. A scan revealed an unstable left hip. The acetabular component was mal-positioned and a screw was exiting medially past the pelvic brim. The patient underwent further revision surgery, with consultant B, but was left with chronic pain and required to use a walking stick for ambulation.

The patient commenced legal proceedings against consultant A.

Learning points

1. Timely Response to Postoperative Complications: There was a significant delay in responding to the patient’s ongoing postoperative complaints. It is essential to ensure any postoperative complications are investigated and managed in a timely and appropriate manner.

2. Informed Consent and Patient Communication: This case highlighted inadequate discussion of potential surgical complications. Clinicians should ensure they have a meaningful discussion with the patient prior to any procedure to enable the patient to make an informed choice. This includes explaining the details of the surgical procedure, risks (known complications including the possibility of chronic pain), benefits and alternatives, including conservative treatment. In addition, consider what is most important to the patient, taking into account their lifestyle and employment.

3. Informed Consent as a Risk Factor: Inadequate informed consent is commonly identified as a contributory factor in a patient’s dissatisfaction with the care provided, which can lead to litigation. Clinicians should refer to GMC’s guidance on Decision making and consent.

4. Ongoing Skills and Knowledge Development: Consultants should ensure their skills and knowledge of surgical techniques are regularly updated and that they follow best practice guidance. Ongoing evaluation of procedural skills and competency is essential. Surgeons should engage in performance improvement opportunities to continuously enhance their technical skills.

Summary

Adverse patient outcomes rarely arise from a single cause. Suboptimal technical skills, such as poor surgical technique, are often identified as a contributory factor in clinical negligence claims. Non-technical skills, including the lack of shared decision-making and poor communication leading to inadequate informed consent, also play significant roles in adverse surgical outcomes.

If you receive a complaint from a patient or a patient suffers an adverse event, please call the PMP medicolegal helpline as soon as possible, in line with the terms and conditions of your policy. The PMP medicolegal helpline team can assist customers in preparing an appropriate response. Contact details for the medicolegal helpline can be found on your policy documents.