Latrogenic chemical arthritis

An 18-year-old rugby player was admitted to hospital with a relatively minor tear of the lateral meniscus of the left knee and he underwent arthroscopy.

The surgeon intended to irrigate the joint with normal saline but was instead handed formal saline (a ten per cent solution of formaldehyde in saline, and thus an irritant hyperosmotic disinfectant) left over from a previous case.

The surgeon realised the mistake and immediately irrigated the knee with large quantities of normal saline. He then continued with his examination which revealed a small transverse tear in the lateral meniscus, which did not require removal.

Postoperatively the patient's knee was swollen and inflamed, and the medical staff recognised that he had an acute chemical arthritis. Over the ensuing years there was significant deterioration of the knee, with stiffness and pain. There was clinical and radiological evidence of early osteo-arthritis.

A substantial claim was inevitable because the patient was unable to realise his sporting ambitions and was likely to be placed at some disadvantage on the labour market. It was agreed that the MDU would be responsible for one third of the damages (on behalf of its consultant member), with the health authority assuming the other two thirds on behalf of the errant theatre staff. The case was settled after a considerable amount of time and money had been expended on determining the value of the case (quantum).

This guidance was correct at publication 01/03/2002. It 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.

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