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There are a number of areas where medico-legal problems can arise is relation to knee surgery:
1) A failure of technique can be very easy to spot using X rays or MRI scans. There can be dispute between experts as to what is acceptable and what is not acceptable. Clearly none of us get it right all the time!
2) Infection can be a common cause of anxiety and patient’s dissatisfaction. Clearly having an infection in the first place is not necessarily negligent. The risk of infection is 1% or less.
Problem areas are a delay in diagnosis of the infection and insufficient treatment. Diagnosis can be quite difficult. Aspiration of the knee to obtain fluid may show no organisms even though the total knee replacement is clearly infected.
The first line of treatment in an acutely infected knee after surgery would be a washout. This would be followed by the appropriate antibiotics intravenously for a period of 10 days. In the early stages, the result of treatment of infection may well settle, but sometimes it is necessary to remove and replace the knee replacement. This can be quite debilitating. There is a risk of infection occurring again after treatment which can lead to amputation.
3) Deep venous thrombosis is relatively common after total knee replacement. It is important to realise that there are no clinical signs which point towards it and tests would be needed to determine this.
4) Stiffness can be a problem after the operation. It can be as a result of pain and failure to move early. It is unlikely to be a cause of successful claim for negligence unless the knee replacement had been put in too tight.
5) Neurovascular injury involves the structures of the popliteal artery, the popliteal and tibial nerves. This is very straightforward. In the standard primary total knee replacement if injuries to these structures occur, this would certainly be regarded as negligent and a failure of technique.
6) The most difficult situation is where pain continues despite there being an apparently good operation. Clearly there can be many reasons why pain would occur and it is not easy sometimes to identify a cause. It is very unusual in the presence of pain in an apparently successful total knee replacement for there to be any negligence.