Decision Report 201204094

Summary

After she was diagnosed with osteoarthritis (the most common form of arthritis), Mrs C had hip replacement surgery. She went back to see the surgeon because she had pain in her hip. He thought that her symptoms suggested trochanteric bursitis (a condition that causes pain over the outside of the upper thigh, usually due to inflammation or injury to some of the tissues that lie over the top of the thighbone). He injected the tender area with a local anaesthetic and steroid on a number of occasions and arranged for her to attend physiotherapy.

When the problems persisted, Mrs C was referred to another surgeon. He said that the pre-operative x-ray showed minimal osteoarthritic change, and thought that the diagnosis of trochanteric bursitis was improbable. He said that the pain might be related to infection or mechanical loosening and organised a bone scan and then an MRI scan, although these did not show any abnormality. The surgeon decided that there were some problems with the hip replacement and that there was enough evidence to support replacing it with a different type. He then carried out this operation.

Mrs C complained to us that the board had failed to carry out appropriate hip replacement surgery in the first operation. After taking independent advice from one of our medical advisers, however, our investigation found that it was reasonable and appropriate to carry out a total hip replacement and that the surgery was carried out to a reasonable standard. Although the first operation failed to achieve the aim of the surgery, which was pain relief, the operation note was clear and did not indicate any problems. A small number of patients have significant pain following hip replacement and we were unable to say what had caused Mrs C's pain. There were no identifiable technical errors and we found that the initial surgery was carried out to an acceptable standard.