MEDICO LEGAL M A G A Z I N E
LITIGATION AFTER TOTAL HIP REPLACEMENT SURGERY By Mr Nikhil Shah, Consultant Trauma and Orthopaedic Surgeon, Wrightington Hospital Lancashire Total hip replacement (total hip arthroplasty) has been described as the “Operation of the Century” (The Lancet 2007). It is one of the most successful procedures to improve the quality of life and relieve the pain of patients afflicted with crippling painful hip arthritis. It was pioneered by Sir John Charnley in the 1960s at Wrightington hospital in Lancashire. The cemented Charnley hip replacement (commonly referred as Low Frictional Torque arthroplasty) performed for the first time in 1962, still remains the Gold Standard when one talks about long term results, now entering the fifth decade of prosthetic survivorship. Unfortunately, like all other surgical procedures, it has well-recognised although often uncommon complications. Sometimes these complications can give rise to litigation. One of the common reasons for litigation is nerve injury during surgery. This is a recognised complication in approximately 1% after primary hip replacement. There are important nerves that lie in close proximity to the hip joint and surgeons are trained to protect these nerves. It is important to assess patients thoroughly before surgery to check if there are pre-existing nerve problems or weakness arising from spine conditions. Despite the surgeon’s best efforts however, rarely nerves can get injured. Injury can occur due to pressure, stretch or direct trauma from sharp instruments. However, in as many as 50% of the cases, the cause might remain unknown. If the injury is incomplete the nerve may recover but complete injury may result in permanent long term problems such as pain, reduced sensation or weakness of muscles. Nerve injury is not synonymous with negligent surgery. Leg length inequality is also a common problem leading to complaints and litigation. It can be
24
associated with dissatisfaction, pain, poor function or even nerve injury. The primary goal of a hip replacement is to relieve pain and achieve a stable hip. It is nearly impossible in every case to assure equal leg lengths. Many patients (up to a third of the normal population) may have unequal leg lengths even before surgery. This may be due various causes such as the arthritis itself, hip deformity, spinal curvature, old fractures of the long bones, pelvic obliquity, or childhood developmental problems. It is important to perform a meticulous clinical examination of the patient including spinal examination and document leg lengths before surgery. Some asymmetry of leg lengths is almost inevitable after hip replacement even after using techniques to measure leg lengths during surgery. It is important that patients are appropriately
