Sometimes after a patient undergoes a hip replacement, the hip can dislocate, requiring additional procedures. This risk rises significantly for revision surgeries, which in turn, typically requires different recovery methods and strict adherence to movement precautions.
As with any surgery, the post-operative care for a patient includes regular monitoring of pain levels, which should be reflected in medical charts upon seeing the patient. Physicians have a responsibility to take pain complaints seriously and properly follow up on a patient’s recovery.
If post-operative protocol is not adequately followed, infection can occur, which, again, requires diligent care from the surgeon. Specifically with hip replacements, catching infections early is critically important because the materials that the implants are made of can acquire bacteria that prevent the immune system and standard antibiotics from fighting the infection effectively.
Delaying treatment for infection can lead to implant failure, severe chronic pain, the need for complex multi-stage surgeries, and a drastically higher risk of death.
In this case, our client’s needs were not met, resulting in two years of severe pain. Not only did her surgeon fail to accurately recognize the source of the pain, but he also performed unnecessary surgeries, ultimately causing her more pain.
Our client suffered from permanent scarring, ongoing pain, and emotional distress from her experience. The Townsley Law Firm fought for her and secured a settlement of over $1,000,000.
What Happened: Two Years and a Surgeon Who Never Looked at the Hip He Operated On
The Surgery and the Immediate Complication
Our client had a history of lower back and hip pain. When she presented to her orthopedic surgeon, he assessed her and concluded that her pain was originating from the hip. He recommended and performed a total hip replacement.
Within days of the procedure, her hip dislocated. The prosthetic joint came out of the socket, a painful and serious complication that required a return to the operating room. The surgeon performed a revision of her left total hip arthroplasty, a corrective surgery to address the failure of the original procedure.
She now had two hip surgeries within a short period of time, and still, her pain did not resolve.
Two Years of Dismissed Complaints
Over the following two years, our client returned to her surgeon six times. At each appointment, she reported the same thing: she was in pain. She was not describing mild discomfort or the expected soreness of post-surgical recovery. She rated her pain a ten out of ten, the maximum score on a standard clinical pain scale, at every visit.
Her surgeon’s response was consistent. He attributed her pain to her lower back, not to her hip or to either of the two surgeries he had performed. He told her directly that her complaints were “certainly not related to any of her surgeries.” He did not order imaging of the hip or perform an aspiration to test for infection. He documented in her medical record that she was doing really well and never sent her to get a second opinion.
A patient reporting ten out of ten pain and a physician documenting that she is doing really well are not describing the same clinical encounter. The documentation he created shielded him from accountability while his patient continued to suffer.
The Unnecessary Back Surgery
On the basis of his repeated conclusion that her pain was coming from her lumbar spine rather than her hip, her surgeon performed an L4-5 laminectomy. This is a spinal procedure in which part of a vertebra is removed to relieve pressure on spinal nerves and address lumbar disk disease.
She had not asked for back surgery. The laminectomy was performed because her surgeon had committed to the explanation that her pain was lumbar in origin and continued to act on that explanation without adequately investigating whether it was correct.
After the back surgery, she was still reporting hip pain. The laminectomy did not help because her pain was never coming from her lumbar spine. Her surgeon told her to return in four to six weeks without explaining or investigating what could be causing her ongoing hip complaints.
She did not return to him.
How She Found Out the Truth
Our client saw her primary care physician, who ordered X-rays of her hip. Those X-rays revealed that the acetabular component, the cup-shaped prosthetic socket implanted into her pelvis during her original hip replacement, was significantly rotated and loosened. This was visible on a standard X-ray. It had been present inside her body while her surgeon told her six times that her complaints were not related to her surgeries.
Her physical therapist referred her to an orthopedic specialist, who performed a joint aspiration, drawing fluid from the hip joint and sending it to a laboratory for analysis. The results came back positive for Staphylococcus aureus.
She had a staph infection in her prosthetic hip. This was the first time in two years that she was told the truth about what was happening inside her own body. Her hip surgery failed, and the implant moved and loosened. The surgical site was infected with one of the most serious bacteria capable of colonizing a prosthetic joint, and her surgeon spent two years telling her she was fine.
What It Took to Repair the Damage
Because the infection had been allowed to persist and progress for two years without treatment, the intervention required to address it was far more extensive than it would have been had the infection been identified early.
The orthopedic specialist was required to:
- Completely remove the failed prosthesis from her hip
- Insert an antibiotic spacer, a temporary cement implant saturated with antibiotics, to deliver concentrated antibiotic therapy directly to the infected joint space
- Allow sufficient time for the infection to clear before any reimplantation could take place
- Perform a pelvis reconstruction to address the structural damage caused by the loosened and rotated component
- Perform an entirely new total hip replacement once the infection was cleared
Our client endured multiple additional major surgeries. She developed permanent scarring. She experienced prolonged and significant physical pain and suffering. She suffered emotional distress, mental anguish, and anxiety. Her enjoyment of life was substantially diminished. Her medical expenses increased dramatically as a direct consequence of her original surgeon’s failure to investigate what was causing her pain.
All of it was preventable. All of it was the result of a surgeon who, for two years, chose his preferred explanation over the clinical obligation to actually look.
What the Standard of Care Required at Every Stage
The standard of care in Louisiana requires an orthopedic surgeon managing a post-operative patient with persistent pain to conduct a thorough and ongoing evaluation of potential causes. This includes reviewing appropriate imaging of the surgical site to assess component position and integrity, monitoring inflammatory markers through blood testing, performing or ordering a joint aspiration if infection is clinically suspected, and referring the patient to a specialist or seeking additional consultation when the cause of symptoms cannot be identified.
When the same patient presents six times over two years with consistent reports of severe pain following hip replacement surgery, the standard of care does not permit the surgeon to attribute those complaints to an alternative anatomical source without adequate imaging evidence and to perform additional surgery on that alternative source without resolving the original complaint.
Our client’s surgeon did all of those things. The Townsley Law Firm presented the evidence of those repeated failures, supported by expert medical testimony, and secured a settlement of over $1,000,000 that reflected the full scope of harm those failures caused.
How Falsified or Inaccurate Medical Documentation Contributes to Malpractice
Medical records are the official account of a patient’s clinical course. They are relied upon by every provider who subsequently treats the patient, by insurers making coverage decisions, and by courts evaluating whether the standard of care was met. When a physician’s documentation does not accurately reflect what a patient reported during an appointment, the harm extends beyond the individual encounter.
In our client’s case, the gap between her reported pain level and her surgeon’s documentation was consistent across multiple appointments spanning two years. She reported ten out of ten pain. He documented that she was doing really well. This pattern of documentation created a false clinical record suggesting that a patient with a severely infected and mechanically failed hip prosthesis was recovering normally.
Inaccurate or misleading documentation in a medical record can constitute an independent breach of the standard of care. It deprives subsequent providers of accurate information, it prevents the patient from understanding the true state of their health, and it creates a barrier to accountability by obscuring the actual clinical picture. In litigation, the contrast between a patient’s testimony about what she reported and a physician’s written documentation becomes powerful evidence for the jury or, in a settlement negotiation, for the parties evaluating the strength of the claim.
What Is a Failed Total Hip Replacement and How Should It Be Identified?
A total hip replacement involves removing the damaged ball and socket of the natural hip joint and replacing them with prosthetic components. The acetabular component is the cup that is implanted into the pelvis to serve as the new socket. The femoral component replaces the ball at the top of the thighbone. These components are designed to replicate the function of a healthy hip joint and provide stable, pain-free movement.
Hip replacement components can fail in several ways. They can loosen from the bone over time as the bond between the implant and the surrounding tissue degrades. The acetabular component can rotate or shift out of its intended alignment. The joint can become infected during or after surgery as bacteria reach the implant through the bloodstream or through the surgical wound.
Identifying a failed hip replacement requires clinical evaluation combined with appropriate diagnostic tools. X-rays can reveal component loosening, migration, and rotation. Blood tests can detect elevated inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, that suggest infection or implant failure. A joint aspiration, drawing fluid from the hip and testing it in a laboratory, is the most direct method of confirming or ruling out infection.
None of these investigations were conducted by our client’s surgeon over two years of post-operative follow-up, despite her consistent reports of severe pain. A plain X-ray obtained by her primary care physician ultimately revealed what should have been identified years earlier.
What Is Staphylococcus Aureus and Why Is a Prosthetic Joint Infection So Serious?
Staphylococcus aureus is a bacterium that is a frequent cause of surgical site infections and prosthetic joint infections. It is particularly dangerous in the context of an implanted device because of its ability to form a biofilm, a structured layer of bacteria that adheres to the surface of the prosthesis. Once a biofilm forms, it creates a protected environment where bacteria are shielded from both the immune system’s defenses and from the effects of antibiotic therapy.
This is why a prosthetic joint infection cannot be treated with antibiotics alone. The standard of care requires surgical intervention: removing the infected prosthesis, placing an antibiotic spacer to clear the infection from the joint space, and reimplanting a new prosthesis only after the infection has resolved.
The consequences of delayed treatment in a prosthetic joint infection are significant and compounding. The longer an infected implant remains in place, the more extensively the bacteria colonize the surrounding bone and soft tissue. The more extensive the colonization, the more complex and destructive the reconstruction required. The more complex the reconstruction, the greater the patient’s pain, recovery time, risk of complications, and permanent functional consequences.
Our client’s two-year delay in diagnosis did not simply mean she suffered longer. It meant that the intervention required at the end of those two years was dramatically more invasive, more damaging, and more consequential than it would have been had the infection been identified at any earlier point.
What Is an Antibiotic Spacer and What Does It Mean for a Patient’s Recovery?
An antibiotic spacer is a temporary implant fabricated from bone cement that has been mixed with antibiotics. After an infected hip prosthesis is removed, the spacer is placed in the joint space to serve two functions: it maintains the anatomical space so that a new prosthesis can eventually be implanted, and it releases antibiotics directly into the infected tissue at concentrations far higher than systemic antibiotic therapy alone can achieve.
The use of an antibiotic spacer means that the patient has no functional hip joint during the treatment period. Mobility is severely restricted. The patient must be monitored with repeated blood tests and often repeat imaging to confirm that the infection has cleared before reimplantation can take place. This process typically takes weeks to months. For a 61-year-old woman who had already spent two years in pain, the addition of this extended treatment period represented a profound and ongoing impact on her daily life and physical function.
The requirement for an antibiotic spacer was not an unavoidable aspect of her hip replacement. It was a consequence of her original surgeon’s failure to diagnose and treat the infection that had been present in her joint since her surgeries.
