Orthopedic Surgeon Gives Improper Orders for Knee Device

Michael Talve, CEO

Written by
— Updated on January 7, 2022

Orthopedic surgeonThis case involves the incorrect use and positioning of a continuous passive motion device on a patient’s leg following a total right knee replacement surgery. The medical records showed that the patient’s leg was placed into the device without a foam boot and, as a result, her leg was not maintained in a neutral position while the device was in operation. Furthermore, the patient was not given a control to stop the device, which caused the patient to receive therapy for longer periods than originally intended. The patient was discharged from the hospital with an area of redness and induration that eventually progressed to a full thickness wound. The patient had to undergo several rounds of surgical debridement and extensive, year-long treatments by a plastic surgeon to close the wound. An expert in decubitus ulcer care was considered to opine on this issue.

Question(s) For Expert Witness

  • 1. Should this problem have been noticed before discharge, and what are the earliest signs to identify skin damage before it becomes a serious issue?

Expert Witness Response E-000055

Providers working with persons at risk need to be able to recognize skin changes that might indicate an impending breakdown. This is particularly true in elderly patients or in patients who are immunocompromised because the signs of impending or fulminating infection are frequently absent in these patients. Systemic signs of infection that mark the need to culture wounds include malodorous drainage, leukocytosis, fever, hypotension, increased heart rate, and changes in mental status. The earliest clinical evidence of damage to the skin is inflammation of the skin that blanches on application of digital pressure. This process originally presents like a hyperemic response, however, unlike hyperemia, the inflammation persists longer. Prevention of progression to more serious damage requires immediate, complete elimination of pressure to the involved area.

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