Poor intraoperative positioning during knee surgery results in permanent nerve damage

This case involves a thirty-nine-year-old male patient who underwent a left meniscus allograph replacement surgery. The surgery was performed on the patient’s left knee. Immediately following the procedure, in the post-operative recovery room, the patient began to experience significant pain in his right leg which had not been operated on. Initially, the treating orthopedic surgeon suspected that the patient had a large hematoma formation which was causing the patient. However investigations revealed that this was not the case and it was determined that he developed severe nerve damage in this leg during the procedure. It was suspected that this occurred, most likely, as a result of a positioning malfunction during the surgery. The position in which the patient was placed for the duration of the procedure, which took several hours, placed a great deal of strain on the patient’s nerve and resulted in the pain he experienced post-operatively. The patient’s condition did not improve up to two years after the procedure and he continues to experience severe pain in the right leg. Despite seeking treatment a several different facilities the patient’s nerve damage did not resolve or improve, even marginally since. Successive neurology consults have confirmed that the damage to the right knee would be permanent and irreversible.

Question(s) For Expert Witness

Is it the surgeon’s responsibility to ensure that the patient is positioned safely, prior to performing this sort of a procedure? Have you ever had a patient develop severe nerve damage as a result of positioning during a procedure?

Expert Witness Response E-006660

It is absolutely the treating surgeon's responsibility to ensure that the patient is positioned safely, prior to undergoing this sort of a procedure. This is sometimes pawned off on nursing staff or to the anesthesia team but ultimately it is fully up to the surgeon to position the patient in the means required for the procedure to be conducted correctly and most importantly safely. Meniscus transplant surgery is fairly rare in general but I probably average about one or two cases per year over the last six years. The type of "repair" for this technique however is implemented somewhat more routinely (inside-out meniscus repair, etc.) and I do this several times per year. I personally have never had a patient develop severe nerve damage as a result of intraoperative positioning.