£80,000 settlement secured for three unnecessary keyhole knee operations and negligent total knee replacement surgery

Case Studies

£80,000 settlement secured for three unnecessary keyhole knee operations and negligent total knee replacement surgery

We have secured settlement for our client, who pursued a clinical negligence claim in relation to her treatment for knee pain against her former private orthopaedic surgeon, Mr Sait. This summary is one in a series of case studies concerning similar claims.

The claim arose in relation to three main allegations against Mr Sait. It was alleged that he (i) performed keyhole knee operations that had no merit in improving our client’s left and right knee symptoms, and in any event failed to obtain her informed consent to treatment; (ii) failed to obtain our client’s informed consent to left total knee replacement surgery; and (iii) performed the knee replacement surgery to such a poor standard that it was negligent.

Factual background

Our client had previously undergone surgery on both shoulders under Mr Sait, in 2005 and 2006, which she had felt had gone well. In 2010 she developed pain in both of her knees and visited her GP. The GP arranged x-rays of her knees, which showed some calcification in the joint spaces and evidence of degenerative calcium pyrophosphate deposition (CPPD) disease. Our client was referred to see Mr Sait for further opinion and, if appropriate, management – she saw him in July 2010.

Mr Sait’s suspicion at the initial consultation was of a right meniscal tear. He suggested keyhole surgery on the right knee but on 1 September 2010 performed keyhole surgery on our client’s other (her left) knee. A tear of our client’s medial meniscus was treated. The right knee keyhole surgery was performed in November 2010.

By December 2010, our client’s pain in her left and right knees was ongoing. She had an MRI scan of her left knee and Mr Sait advised and performed repeat keyhole surgery. This procedure did not rid our client of her pain, which continued. She subsequently had an injection into her knee and then a manipulation of her left knee whilst under anaesthetic.

Approximately 18 months later our client saw Mr Sait again because of pain in both of her knees. At this time Mr Sait recommended a total replacement of our client’s knee, which he then performed in April the following year.

After surgery our client’s evidence was that she continued to have discomfort and pain in her knee. She attempted to rehabilitate her knee with over 100 sessions of physiotherapy and hydrotherapy, but her symptoms continued. At some of these sessions our client bumped into Mr Sait in passing, at which he reassured her that her symptoms would improve over time. Our client accepted that advice.

By October 2016, three and a half years after her knee surgery, our client attended her GP because she had noticed a lump. Her GP thought that there was a retained staple in her knee and our client was referred to a different orthopaedic surgeon, Mr Thilagarajah. She could not see Mr Sait again because, by this point, he had been suspended by Fawkham Manor Hospital.

Mr Thilagarajah arranged new x-rays of the knee and found that there was “significant mal-alignment” of the knee components: ie that Mr Sait had implanted the knee components in the wrong position. Mr Thilagarajah advised our client that this was likely the cause of her symptoms. Our client was referred to another orthopaedic surgeon who specialised in revision surgery, Mr Moftah. He agreed that the knee components had been implanted incorrectly and were also too large for our client’s natural anatomy. Following this advice, our client underwent revision surgery, after which she experienced a reasonable recovery.

The claim

Penningtons Manches Cooper was instructed and, after obtaining a copy of our client’s medical records, we obtained evidence from an expert knee surgeon. That expert confirmed his opinion that Mr Sait i) failed to acknowledge our client’s calcium pyrophosphate disease, which should have been managed conservatively in the first instance; ii) recommended keyhole surgery without our client suffering any mechanical symptoms and there being no radiology imaging to support this form of management; iii) failed to advise our client that keyhole surgery was unlikely to improve her knee symptoms and failed to obtain her informed consent to treatment; iv) failed to advise our client of the alternative options for her knee, other than knee replacement, and failed to obtain her informed consent to knee replacement surgery; and v) performed knee replacement surgery to a very poor standard - the implant components were too large for our client’s knee and positioned negligently.

Following receipt of our expert’s evidence, we alleged negligence against Mr Sait. It was alleged that, had our client been appropriately advised by Mr Sait, she would have avoided three keyhole surgeries on her knees. In addition, we alleged that the negligent positioning of the knee implant components caused the knee replacement to fail and our client to need revision surgery within four years of her primary surgery. We alleged that had our client been appropriately advised prior to knee replacement surgery she would have chosen conservative options and would not have needed to have a knee replacement during her lifetime. Finally we alleged that had the knee replacement been performed acceptably, our client would have had a good outcome from treatment and would have avoided the need for revision surgery.

Mr Sait denied all of the allegations against him in full. He argued that he assessed our client acceptably, advised her of the options for her knee treatment, and that she consented to the three keyhole operations. He also argued that the knee replacement was performed to a suitable standard.

Our expert remained robustly in support of our client’s case and did not accept the arguments presented by Mr Sait. Court proceedings were subsequently issued and served upon him.

The claim proceeded through the court timetable. The parties exchanged witness evidence and, prior to exchange of expert evidence relating to breach of duty, the solicitor for the defendant advanced an offer to settle the claim. After discussing this case with our client, her instructions were to try to achieve a reasonable settlement of her claim quickly, if possible. We advised our client that we would not recommend settling the claim at any cost, or at a level that would undervalue her claim. We did, however, engage in negotiations with the defendant’s solicitor and were able to agree a settlement of this claim for £80,000. Mr Sait made no formal admission of liability in this case but our client was content to have reached a resolution to her claim.

Our client experienced a number of years of knee pain due to the alleged negligence and we are pleased to have been able to achieve a reasonable settlement to compensate her for the pain and suffering she experienced, as well as the financial costs she incurred in managing her discomfort.

Should you have concerns over the management of any orthopaedic surgeries, either in an NHS or private setting, please do not hesitate to contact a member of the clinical negligence team.

Other case studies in this series

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Penningtons Manches Cooper LLP is a limited liability partnership registered in England and Wales with registered number OC311575 and is authorised and regulated by the Solicitors Regulation Authority under number 419867.

Penningtons Manches Cooper LLP