This surgical malpractice claim was filed in Harford County after an orthopedic surgeon failed to even out a woman's leg length discrepancy during her second hip replacement procedure. It was filed in Health Claims Arbitration on February 8, 2018, and it is the 68th medical malpractice case filed in Maryland this year.
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A 55-year-old woman presented to her orthopedic doctor for a consultation about her left hip and groin pain. After performing a physical exam and ordering x-rays, the doctor diagnosed the woman with arthritis in both hips, the left greater than the right. He advised against physical therapy because the arthritis was so advanced, and instead recommended a left hip replacement.
The doctor performed the hip replacement at Upper Chesapeake Medical Center. A note indicates that the woman required bone grafting during the procedure due to a protrusion process. The woman went back to her doctor two weeks later for a post-surgical follow-up. X-rays showed that the hip replacement was in good condition, and she was asked to return for another follow-up in four weeks.
At the second follow-up, the woman reported no pain but the doctor noticed that she had a leg length discrepancy of an inch. He ordered a one-inch shoe lift and instructed her to return in three weeks. The woman was no longer using a walker at her third appointment, but she was limping due to her leg length discrepancy.
Three weeks later, four months after the hip replacement, the woman returned to her doctor with complaints of knee pain and severe right hip pain whenever she moved. An x-ray showed bone-on-bone arthritis of the right hip, so the doctor ordered a CT scan and recommended right hip surgery. He told the woman that the surgery would equalize her leg lengths.
During the right hip replacement surgery, the doctor did not use properly-sized femoral components. As a result, the second surgery did not even out the woman's leg lengths. When the woman returned for her post-surgical appointment, noticing the continued difference in her leg lengths, her doctor advised against correcting it. He recommended that the woman returns in three years for repeat x-rays and a routine check-up.
The woman sought a second opinion from another orthopedic surgeon. The new doctor performed surgery to lengthen the woman's right leg. He succeeded in reducing some of the woman's leg length discrepancy, but unfortunately, the woman continues to suffer from a leg length difference of about a half-inch.Additional Comments
Equivalent leg lengths are important in hip replacement, as leg length discrepancy (anisomelia) can lead to a higher risk of low back pain, spinal dysfunction, hip joint misalignment, uneven knee wear, unsteady walking, aseptic loosening of hip prostheses, abnormal standing balance, stress fractures and a variety of other lower extremity issues.
There is no question different lengths can happen in the absence of negligence. This case is going to hinge on the question of what the evidence with show with respect to the allegation that the doctor did not properly size the femoral components.
This case was filed on the eve of the statute of limitations with no expert report.
The revision surgery was somewhat successful. The doctor's lawyers are expected to argue that a half-an-inch is can be corrected with a shoe lift. (Then again, there is a lot of literature that says that anyone over .39 inches is unacceptable.) You can also expect the argument that the plaintiff's real problems are patient's continuing pain complaints are due to multiple musculoskeletal factors outside of the control of the surgeon.
Hip replacement surgeons know that excessive leg length due to improper component sizing is one of the most common occurring avoidable complications of this procedure. In the unusual circumstance where the anatomy of the joint does not permit exact leg length equality post-operatively.
- Harford County
- An orthopedic surgeon
- Upper Chesapeake Orthopedics
- Upper Chesapeake Medical Center
- Failing to use properly-sized prosthetic components.
As a result of the defendants' negligence, the woman suffered an unreasonable leg length discrepancy which caused limitations, restrictions, and an additional surgery.
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