Decision Report 201304706

Summary

Miss C complained there was an avoidable delay before her hip replacement surgery was carried out. We took independent advice from one of our medical advisers, who explained that total hip replacements are best avoided in younger patients until all other possibilities have been considered. This is because such replacements have a limited time span and in younger patients they wear out and loosen earlier due to physical activities. In such cases the patient might need at least one further surgery, if not two. As Miss C was a younger patient, the delay before surgery was appropriate as it was important to explore all other non-surgical options before operating. We also found that Miss C asked to delay the surgery further, for personal reasons, and so not all of the delay was caused by the surgeon.

Miss C had replacement surgery on both hips. While the right hip surgery was successful, Miss C experienced pain after the surgery on her left hip and needed another operation. She complained that there was a failure to take timely action or arrange appropriate investigations to try to diagnose the cause of her pain. Our adviser said, however, that the investigations carried out on this were reasonable and appropriate. In particular, after unsuccessful surgery there may be complications with a further operation, and the adviser said that it was reasonable to wait and see if a patient's symptoms settled down (which in many cases they do) before taking further action.

Although we did not uphold Miss C's complaint, our adviser noted that the cause of Miss C's pain and her dissatisfaction with the surgery on her left hip was likely a direct consequence of the hip replacement socket being badly positioned. Our adviser said that in this respect her care and treatment fell below an acceptable standard, and we made recommendations about this.

Recommendations

We recommended that the board:

• apologise to Miss C for failing to ensure that her left hip replacement operation was undertaken to a reasonable standard of care; and
• carry out an internal audit of any known or reported complications of the doctor's surgery and a review of all postoperative x-rays of the hip replacements performed by them over a twelve month period; report to us the findings of the audit and in the event that this shows that Miss C's case was not an isolated incident inform us of the action they intend taking to address this; and raise the findings of our investigation with the doctor for reflection.