Malpractice defense: Complications post op partial hip replacement

In addition to my consulting work and writing the Health Business Blog, I’m chairman of the board of Advanced Practice Strategies (APS), a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety.To learn more contact: Timothy Croke, Director of Demonstrative Evidence Group. tcroke@aps-web.com or 617-357-0553 ext. 6664.Here’s the Advanced Practice Strategies case of the month.Judgment for the DefenseComplications Post OpPartial Hip ReplacementAn 84-year-old patient underwent a joint replacement surgery (right Austin Moore arthroplasty) during which a dysfunctional femoral head is replaced with an Austin Moore prosthetic. The surgery was performed on September 17, 2001, and the patient encountered postoperative complications that ultimately resulted in a total hip replacement.PLAINTIFF'S CLAIM: The plaintiff claimed that the implant size, specifically, the prosthetic stem, was incorrect.  If the correct size had been used, the patient asserted, no complications would have arisen and the total hip replacement would not have been necessary.DEFENSE'S ARGUMENT:The defense maintained that the prosthetic was the right size, that the surgery went well, and that films done immediately following the operation confirmed the correct position, placement, and size of the prosthetic. Over time, the prosthetic did loosen, which is a known complication of the original procedure.  Once this was recognized, the appropriate response — a total hip replacement — was undertaken.  In addition, the defense pointed out that the plaintiff’s counsel incorrectly indicated that the joint was replaced with a bipolar prosthetic. In fact, a one-piece Austin Moore prosthetic, with no interchangeable pieces, was used. This was documented in the operative reports and supported by the films taken following the procedure.___________________________________________________________________VISUAL STRATEGY:Using the documentation available, APS prepared a presentation that included diagrams of normal hip-joint anatomy and illustrations of the orthopedic structures involved. We then illustrated the specific posterolateral approach and the surgery done with the specific prosthetic used in this case.Using the postoperative x-ray, we created a film enhancement — directly on the original studies — showing all pertinent structures. This allowed the jury to see that the prosthetic used was the correct size and that the hip was aligned properly.A second board was prepared comparing the two prosthetics discussed, highlighting their differences.Finally, we presented the remaining films.  This served to establish exactly when the prosthetic started to loosen — again, a recognized complication of the procedure — thus demonstrating that the loosening was not due to any negligence by the defendants.This combination of illustrations helped the defense successfully explain the following:

• The surgery was done correctly with the proper prosthetic device.
• The placement was monitored appropriately through a series of postoperative films taken over a reasonable period of time.
• Movement or loosening of the prosthetic is a recognized risk of the procedure and was in no way a result of negligence on the part of the physicians involved.

RESULT:After a short period of deliberation, the jury found in favor of the defense. —Senior Claims Manager, Ronda Brockway, Medical Protective Company forwarded the following email:Tim,Some feedback from Jim Doherty, Esq.Dear Ronda:To follow up our telephone conversation yesterday when I advised you we got a defense verdict, I wanted to let you know that Advanced Practice Strategies did a great job for me in securing excellent illustrations that I used effectively during this trial.  The particular illustrator was Sheri Healy.  She was extremely cooperative.  She created these illustrations pursuant to my request and my client’s input.  She did them in a very professional manner, and she met all of our time limitations.My client called me again this morning to thank me but also to thank Medical Protective for “sticking with him” and not trying to force him to settle the case when he knew he didn’t do anything wrong.Very truly yours,Jim—Attorney, Jim Doherty, Scanlon, Howley & Doherty, Scranton, PA