We have settled a claim on behalf of our client who, following negligently performed hip surgery, was left with leg length discrepancy and a painful hip and back, which caused her to require revision total hip replacement surgery within two years of the initial operation.
Our client began experiencing left hip pain in around December 2013. She visited her GP, who referred her to a private orthopaedic hip surgeon. She attended the appointment at the Holly Private Hospital in Essex the following year, where the surgeon examined her hip and arranged an X-ray. He confirmed that she had developed quite advanced arthritis in her hip and recommended surgery.
Arthritis occurs when the soft tissues between joints deteriorate, which makes movement of the joint more difficult and causes swelling. The condition is often associated with pain, which can become severe if the soft tissues continue to worsen and lead to the bones of the joints rubbing together. Our client was in considerable pain because of her hip and agreed to undergo hip replacement surgery on 6 October 2014.
Hip replacement surgery is a complicated procedure that requires accuracy. A good outcome relies on the surgeon performing the operation competently using appropriately sized components in the correct position such that they recreate the precise biomechanical effect of the patient’s hip and natural anatomy.
After the operation, our client was advised to attend physiotherapy and exercise her hip to build up the muscle strength. She had previously trained as a fitness instructor and followed her surgeon’s and physiotherapist’s instructions to the letter. Despite her efforts, her hip was more painful than it had been before the surgery, and she felt that there could have been a problem with the way in which it had been performed. She walked with a limp and felt that her left leg was longer than it had been before.
Our client returned to her consultant surgeon to discuss her outcome many times. She explicitly asked her surgeon why she had a leg length discrepancy, but her concerns were dismissed and she was repeatedly told that her legs were of equal length and that she only had an apparent leg length discrepancy.
Following hip replacement surgery, some patients do develop a condition known as pelvic tilting or pelvic obliquity. This can occur, particularly during the initial recovery period, when the muscle around the operated hip is weak and movements are more limited. The effect is to cause the pelvis to tilt and give the patient an impression that their leg lengths are unequal. Pelvic tilting (or pelvic obliquity) will usually resolve after physiotherapy and strength building exercises, so it is not uncommon for surgeons to suggest persisting with physiotherapy and exercise in the first instance in order to try to resolve a perceived leg length discrepancy without resorting to surgical methods.
In our client’s case, however, despite continuing with exercise over a number of months, she felt no improvement in her leg length inequality or pain. Walking with unequal leg lengths caused her to develop lower back pain and her mobility was severely restricted. She eventually saw a different consultant surgeon at the Princess Grace Hospital, who physically measured her legs and confirmed that she had a true discrepancy; her left leg was 2cm longer than her right.
Leg length inequality can occur after hip replacement surgery, and a lengthening of less than 2cm is usually considered an unfortunate outcome of the procedure, meaning it may not have been caused by negligence. In some cases, however, it can due to incorrectly sized or positioned components, which may give rise to a claim in negligence.
Our client’s second opinion surgeon arranged further imaging of her left hip. Upon review of those scans, two issues were identified: first, that the components used during our client’s hip replacement surgery were too large, and second, that they had not been positioned to an acceptable standard. It was found that the cup had not been implanted within the socket of the pelvis, which caused our client’s left leg to be in an ‘offset’ position. The incorrectly sized and positioned components therefore caused our client to suffer a leg length discrepancy and her walking pattern to be altered, which had been causing her pain ever since the surgery took place.
Our client was advised that the only way to improve her outcome was to re-operate on her hip and replace the implanted components. As she had been struggling since the initial surgery and was keen for an improvement, she agreed to revision surgery, which was performed on 20 June 2016.
After the second operation, our client felt an almost immediate relief. During initial physiotherapy, she reported that her legs were of equal length and, even during that post-operative period, her walking had returned to being near normal. She continued to attend physiotherapy and it was noted that, after five months, she was completely pain free and walked with a normal gait.
After accepting instructions and obtaining our client’s medical records, we obtained expert evidence which confirmed that the components used during her initial surgery were too large and incorrectly positioned. We submitted a formal letter to the defendant surgeon setting out the allegations of negligence that our expert considered had occurred. In the meantime, we investigated the value of our client’s claim. This involved obtaining witness evidence from our client, which the expert considered and then provided an opinion on her long-term prognosis. After taking instructions from our client on the financial losses that she had incurred because of the negligence, as well as the impact of the negligence on her daily activities and pastimes, we were able to quantify the claim and took instructions to send an offer to the defendant surgeon to settle the claim.
The defendant’s legal representatives did not dispute the allegations. No formal letter of response was provided, but after some initial questions by the defendant’s legal representatives, the claimant’s offer to settle the claim for £31,000 was accepted.
This settlement was a good outcome for our client. The evidence was clear in this case and, rather than dispute the claim and delay settlement, the defendant took a pragmatic approach to resolve the claim quickly, which was in the interest of all parties involved.