Orthopedic Surgeon Installs Hip Implant That Requires Revision

This case involves a fifty-two-year-old patient who sustained a sub-capital right hip fracture following a slip and fall. She was immediately taken to the local trauma center and underwent hip surgery by an orthopedic surgeon. The physician performed a bipolar endoprosthesis of the right hip using a ceramic Stryker Orthopaedics UHR Universal Head Bipolar Component. Following surgery, the patient complained of immediate pain, which remained during the months following the surgery. The patient’s surgeon, however, was sentenced to prison time on financial fraud charges during the course of her follow-up treatment and required the patient to seek treatment from another orthopedic surgeon. The diagnostic testing ordered by the second physician revealed that the source of the patient’s pain was the right hip bipolar prosthesis. Further investigation yielded evidence of a translucent line around the femoral prosthesis. The new surgeon suspected that loosening of the device was most likely the cause of discomfort and the patient was recommended for a total right hip revision surgery.

Question(s) For Expert Witness

1. Can you determine if this patient actually needed the first surgery and, if not, what type of rehabilitation could this patient have benefited from?

Expert Witness Response E-000379

The treatment of femoral neck fractures, intertrochanteric hip fractures, and most tension femoral neck stress fractures requires surgical intervention. Stress fractures occur most often in the femoral neck and are classified according to the location (ie, inferior or compression, superior or tension). Tension fractures have a poor prognosis and tend to be unstable. Compression fractures may heal with conservative management. Furthermore, compression fractures are most commonly treated with several days of rest followed by protected, crutch-assisted weight bearing. Diagnostically, frequent serial X-ray films are recommended to monitor fracture healing and progress and to assess for any changes.