Patient Has Pulmonary Embolism Following Knee Replacement

This case involves a female patient who had her leg amputated following a complication of an outpatient knee arthroscopy. During the procedure, there were a number of vascular issues leading to the decision to amputate her leg. The patient is now disabled and unable to carry out professional obligations.

Question(s) For Expert Witness

1. Is amputation a common complication of knee arthroscopy?

Expert Witness Response

Undergoing a total knee replacement is a low-risk procedure. Thus, complications during and after total knee replacement are uncommon or rare. Any complication can often be prevented with careful surgical techniques and with attentive postoperative management. It is important to take into account the complications during and post surgery, and therefore a careful preoperative assessment is vital. Some of the complications after surgery include anesthesia-related risks, exacerbation of comorbid medical issues (i.e congestive heart failure, atrial fibrillation), and medication/ allergic reactions. At times stasis in the venous system can cause deep vein thrombosis which can lead to pulmonary embolism; it is another complication that can be seen in surgical patients that often undergo surgery due to the immobility of the patient. Surgeons are aware of these risks post-operatively, and thus administer heparin to prevent DVT. Arterial vascular injuries in total knee arthroplasty are exceedingly rare. In this circumstance, an amputation is an uncommon procedure and can be contributed to gross negligence.