Settlement for negligently performed right primary total knee replacement


We have recently settled a claim, for a significant sum, on behalf of a lady who suffered injury during surgery for a right primary total knee replacement.

Our client, a fit and very active 70 year old, developed arthritis in her right knee and underwent what she envisaged would be a straightforward right knee replacement. A series of surgical errors, including errors in a subsequent revision knee surgical procedure, resulted in our client suffering significant injury to her right knee, permanent pain, and loss of mobility. 

During the initial surgery, too much bone was removed from our client’s shin bone (the tibia) when the surgical jig slipped (bone is removed from the top of the tibia during knee replacement surgery to allow the insertion of the prosthetic knee, and a surgical cutting jig is used to guide the path of the cutting tools).

As a result, the knee had to be replaced with a revision-type knee prosthesis - revision-type knee prostheses allow less movement in the knee. Our client did not find out for some time that there had been a surgical error and that she now had a revision-type prosthesis.  

Over the next two and a half years, our client suffered increasing pain and loss of mobility. The prosthetic loosened and she had to have revision surgery. During this surgery, further errors were made. The knee prosthesis was found to have eroded through the outer shell of the tibia. The surgeon was unable to insert a sleeve down the tibia, and so used a metaphyseal sleeve which finished close to the hole in the tibia. 

After the surgery our client was advised to mobilise with full weight-bearing even though, according to our orthopaedic expert, the position of the metaphyseal sleeve put pressure on the opposite side of the tibia. She reported increasing pain around her knee and developed a stress fracture. Our client then had to endure time in a plaster cast. She was switched to a different type of cast, which our expert advised was of the wrong type, and caused our client unnecessary pain.

Our client suffers ongoing discomfort in her right knee. Walking is painful and she is now only able to walk at a slow pace, with a walking stick, for around half a mile. She struggles to manage stairs. Given our client’s age, her functional ability is likely to deteriorate as she ages. She may need further surgery to her right knee, involving significant risks. Before the surgery our client was fit and active. She has struggled to come to terms with the significant levels of pain and disability she now has to endure.

Our client went through the defendant trust’s complaints process. Our specialist team investigated the claim, obtaining expert evidence from a consultant orthopaedic surgeon. A letter of claim was served. The letter of response admitted breach of duty regarding the conduct of the initial knee replacement and regarding the failure to inform our client. Causation was admitted regarding the majority of the allegations in the letter of claim. The defendant trust apologised to our client for the failings in care. Our client was put to proof as to the nature and extent of her injuries. No admissions were made regarding quantum.

We obtained quantum evidence from an occupational therapy expert and an accommodation expert. A preliminary schedule of loss was served, on a without prejudice basis, along with expert reports and witness evidence. The defendant made an initial, low, Part 36 offer which, on counsel’s advice, was not accepted.

The parties engaged in a settlement meeting which resulted in a substantial damages settlement for our client, reflecting not only the pain she has suffered and the care she has needed in the past, but also her future needs, including care, transport and accommodation.


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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.

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