The High Court dismissed a woman’s negligence claim against an orthopaedic surgeon over a 2003 left hip replacement, finding she had not proved that the surgery fell below the standard required of a practitioner of similar skill.
In a judgment delivered on 23 February 2012, Mr Justice John Quirke considered three criticisms advanced by the woman’s expert witness: that the operation disrupted Shenton’s Line, that the surgeon failed to measure or template her leg properly, and that he used an unsuitable 40mm Charnley implant instead of a 35mm three-quarter-offset model.
The woman alleged that the replacement was positioned too far laterally, leaving her unable to walk normally and with one leg longer than the other. The surgeon denied negligence and said he had used appropriate care and skill.
The judge was not satisfied that Shenton’s Line had important relevance to the proper performance of hip replacement surgery or that the surgeon had breached it. The plaintiff’s expert, Mr Kevin Hardinge, had described lateral displacement of up to 2cm, but accepted in cross-examination that this was wrong: the displacement measured no more than 4mm. He withdrew his opinion that the 4mm displacement, by itself, indicated negligence. The court also noted that he had produced no medical authority supporting his view of Shenton’s Line.
The plaintiff complained of a longer left leg within a week of surgery and continued to report groin pain. The judge said he was satisfied those complaints were made, although he did not find her a reliable witness and found parts of her testimony inconsistent. Radiologists disagreed on the precise measurement of the leg-length difference. The court considered it probable that the left leg was between 6mm and 13mm longer. It found no evidence that this difference established surgical negligence and accepted that such discrepancies can be minimised but not eliminated.
On the allegation of inadequate measurement, the judge accepted the surgeon’s evidence about the techniques and templating used. He preferred the evidence of Professor John P. McElwain, who testified for the defence, over Mr Hardinge’s where they differed.
The court also found it had not been proved that using the 40mm implant departed from general and approved practice. On the evidence, it considered that using the proposed 35mm implant might instead have departed from that practice.
Applying the principles for medical negligence claims set out in Dunne v National Maternity Hospital, the judge found no other negligence allegation had been made or proved. He dismissed the claim. The judgment does not record a damages award or a separate costs order.