Patient Undergoes Joint Replacement Due to Surgical Infection

Orthopedic Expert WitnessThis case involves a male patient with an unremarkable medical history who injured his left knee during a recreational softball game. The man was taken to the hospital after his injury , where an x-ray revealed a tear in the meniscus of his left knee. His physician elected to attempt a surgical repair through arthroscopic surgery, which proceeded without major incident. Nevertheless, the patient developed redness, pain, and a fever shortly after surgery, and doctors diagnosed him with a deep tissue infection. The infection was able to progress, allegedly due to insufficient treatment, and the man’s knee suffered extensive and permanent damage as a result, which forced him to undergo a total knee replacement.

Question(s) For Expert Witness

  • 1. How often do you perform arthroscopic knee surgery?
  • 2. What procedures or protocols should be in place to prevent unnecessary anthroscopic knee surgery?
  • 3. In a patient with this type of presentation, what would be considered the standard of care for treatment of postoperative infection?

Expert Witness Response E-017978

The standard of care for treating a postop knee infection dictates an urgent attention to the patient’s situation delivered by:

  1. Hands-on evaluation of the patient within a day or
  2. Review of initial patient complaints that something “seems wrong” including basic examination of the patient looking for clinical signs of a worsening clinical picture such as a painful effusion, drainage, wound/portal breakdown, joint stiffness out of proportion to what is expected for a basic knee arthroscopy, skin redness, erythema, increasing warmth, streaking or an elevated temperature.

A thorough evaluation of the suspected condition with appropriate workup such as blood work, Lynne joint aspiration, and analysis via culturing and gram stain for infection, as well as possible consultation with an infectious disease specialist. I have definitely seen similar cases and it is usually a failure to respond appropriately to early signs of infection that get health care providers into trouble. I perform arthroscopy of the knee, shoulder, and hip on a weekly basis with as many as 12-16 cases per week. Using appropriate indications is paramount to negating iatrogenic complications.

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