Sports Medicine Physician Opines on Inappropriate Removal of Joint Cartilage

    sports medicine expert witnessThis case involves a young female patient who began to complain of persistent pain in her left hip some time after giving birth to her second child. After the pain began to get progressively worse, an MRI was ordered. The MRI revealed a tear in the patient’s labrum, a rim of cartilage that provides cushioning and stability to the hip joint. The plaintiff then underwent surgery to repair the tear, however she experienced increased pain as well as difficulty walking following the procedure. A few months after undergoing the procedure, the patient experienced a sudden dislocation of her hip joint while walking. A subsequent MRI revealed extensive joint damage, and physicians elected to operate. During the surgery doctors discovered that the woman had no cartilage in her hip – it had apparently been removed by the operating physician during her original surgery. As a result, the patient was forced to undergo a total Zimmer hip replacement procedure at a young age.

    Question(s) For Expert Witness

    • 1. Do you routinely treat patients like the one described in this case?
    • 2. Have you ever had a patient develop this outcome?

    Expert Witness Response E-017978

    My initial thoughts are that I would love to see the arthroscopic images obtained at the time of initial surgery. It is both customary and a standard of care to obtain objective evidence of what pathology was at the beginning of the case and what the joint looked like after the surgical intervention. It is not expected or ordinary for a young female’s hip with an isolated labral tear to go on to be basically arthritic, requiring a total joint replacement. Nor is it expected for a hip to subluxate after simple labral repair. Postsurgical hip subluxation is a complication of hip arthroscopy that is very rare and should have been discussed in the preoperative consenting process. The literature is ripe with case reports of post-surgical hip arthroscopy subluxation from too aggressive a capsulotomy or capsulectomy without addressing the capsule at the time of closure at the end of the case to stabilize the hip within the socket. I am a sports medicine fellowship trained orthopedic surgeon with 20 years of surgical experience. I have been doing hip arthroscopy for over 15 years. I routinely perform in excess of 80 hip arthroscopies a year as a significant part of my surgical practices.

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