Patient Suffers Deep Tissue Infection Following Routine Cardiac Procedure

Joseph O'Neill

Written by
— Updated on January 10, 2022

Infectious Disease Expert WitnessThis case involves a middle-aged woman in Nebraska with an artificial right hip that had been installed one year before the events of the incident in question. The woman first presented to the hospital with complaints of chest pain and shortness of breath, and was diagnosed with myocardial infarction. The woman underwent cardiac catheterization and received a bare metal stent, during which she was give anti-coagulation medication. One week later, she presented to the hospital again with complaints of right leg pain with diminished range of motion. Over the next few months, she was diagnosed with a hematoma located within her pelvis near the entry point for her catheterization procedure. She continued to present to multiple physicians with pain, erythema, and swelling, however the only treatment he was given was over the counter pain medication. The patient eventually presented to an orthopedic specialist, who re-imaged the joint. Scans showed that the hematoma had become infected. As a result of the unchecked progression, the patient developed an infected right Biomet hip prosthesis and right hip abscess, and underwent multiple revision surgeries.

Question(s) For Expert Witness

  • 1) How often do you treat patients with a similar presentation?
  • 2) Given this patient's history of right hip arthroplasty and bleeding, what steps should be taken to manage the iliac muscle hematoma after being diagnosed?

Expert Witness Response E-043492

I am an active infectious diseases clinician and frequently care for patients with infectious complications related to arthroplasty procedures. I also am the medical director for infection prevention at my large academic hospital and co-lead a performance improvement team focused on the prevention of hip/knee arthroplasty infections. I would recommend that the surgeon explore the hematoma to a.) confirm the diagnosis and ensure that it was not infected, b.) decrease pain associated with it and c.) take action to ensure the hematoma does not recollect. I am currently writing a chapter for an infectious diseases textbook on surgical site infections which will be published in late 2017 or 2018 and I am giving a lecture on the subject at a large community teaching hospital. I am trained in adult and pediatric infectious diseases and post-operative orthopedic infections are a type of infection I frequently care for. I also am the medical director for infection prevention for my hospital, a very large academic tertiary care institution.

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