Orthopedic Surgery Patient Suffers Ongoing Pain From Bone Substitute Implant

This case involves a male patient who had developed a bone void secondary to a broken leg suffered while skiing. In order to treat this void, the patient received an injection of bone substitute. The procedure was performed without evident complications and the material was placed in the proper location. Nevertheless, the patient experienced severe pain over the next day. X-rays appeared to indicate that some of the material had seeped out of the implantation site. The patient returned to his orthopedic surgeon who said that the placement looked normal and that the pain would subside naturally. Further testing by other medical professionals revealed that the bone substitute was impinging on a major nerve bundle, causing permanent damage that would likely produce ongoing pain.

Question(s) For Expert Witness

1. Do you have any experience with bone substitiute injections? What precautions are taken to avoid this complication?

2. What are other possible treatments for chronic microfracture/bone void?

3. How important is a timely diagnosis of this complication (i.e. does it affect prognosis)?

Expert Witness Response E-006313

I have not specifically used this bone substitute compound for this purpose, but I have used calcium sulphate and calcium phosphate composites for years. I used to use them to fill bone voids and have found them less effective, so I now use allograft/autograft bone with bone marrow aspirate. I often use calcium sulphate as a carrier for antibiotics in the face of infection. I have a great deal of experience with bone defects, both traumatic and in osteochondral lesions. The use of a liquid bone filler for bone defects around joints carries a significant risk of extravasation beyond the intended site and requires great caution by the surgeon. Timely diagnosis is important to prevent damage to surrounding tissues from mechanical trauma of the cement.