A 52-year old woman was referred to see an orthopaedic surgeon, a member of the MDU, with a two-month history of left knee pain. She had had a riding accident 25 years previously and had a residual right-sided hemiparesis. The patient complained that her knee felt stiff and swollen. The surgeon found some anterior joint line tenderness and requested an MRI scan which showed bone bruising in the lateral femoral condyle and evidence of condylar flattening and meniscal degeneration. He felt that it would be worthwhile to do an arthroscopy as there might be a treatable abnormality on the lateral meniscus.
There was no record in the patient's notes of discussion of the risks or benefits of surgery, though both the patient and the anaesthetist had signed a consent form for the procedure. At arthroscopy a peripheral tear of the lateral meniscus was repaired. The following day the patient complained of severe pain and experienced brisk bleeding from the lateral portal, which required suturing. The surgeon reassured her.
A week later the knee was still very swollen and painful. An MRI scan showed an effusion. The surgeon carried out a further arthroscopy, obtaining consent in the same manner as before, ie a consent form signed by both the patient and the anaesthetist.
At arthroscopy, the joint was found to be full of blood clots which were washed out. A suture had come out and was replaced. However, the patient was later admitted to her local hospital with pain and fever. She was found to have septic arthritis. She was treated with intravenous antibiotics and the joint was washed out again. Rehabilitation was slow and over the next few months the patient underwent manipulation under anaesthetic to try to improve the range of movement and two further arthroscopies to deal with adhesions and scar tissue.
The expert commented that the consent process was below an acceptable standard and the claim could not be successfully defended.
The patient was left with a small degree of fixed flexion and a reduced range of movement. It was anticipated that she would need a total knee replacement.
A claim was received. The MDU obtained a report from an independent orthopaedic expert. Although the expert was not critical of the decision to proceed with an arthroscopy, he commented that the consent process was below an acceptable standard and so the claim could not be successfully defended. The claimant argued that, because of her existing disability, she would not have proceeded with the surgery had she been properly informed of the risks. This was despite her having had arthroscopies before first coming into contact with the member.
The claim was settled for £66,000 on behalf of the member
Dr Frances Szekely
Senior medical claims handler
This page was correct at publication on 04/12/2013. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.