An orthopedic surgery expert witness opines on a case happened in Alaska where a patient suffers damage to the right iliac artery during a total hip replacement surgery and is left with permanent weakness and disability as a result. This case involves a sixty-two-year-old male patient with a past medical history of osteoarthritis of the right hip. The patient was being managed conservatively with analgesia for pain relief and mobility aids to help him mobilize. The patient’s joint function continued to deteriorate and he sought treatment from an orthopedic surgeon. The orthopedic surgeon evaluated the patient’s hip and found evidence of severe degenerative disease in the affected hip. The surgeon recommended that the patient undergo a total hip replacement using an anterior approach. During the surgery, the patient suffered a transection of the right iliac artery which required emergency intra-operative vascular intervention. Post-operatively the patient suffered a deep vein thrombosis in the right leg which necessitated Lovenox and Coumadin therapy for six months. As a result of the intra-operative complication the patient was left with residual weakness and decreased range of motion in the right leg. His ability to ambulate is now less than it was prior to the surgical intervention.
Question(s) For Expert Witness
- 1. What should have been done to prevent an injury to the iliac artery during a hip replacement surgery?
- 2. Is it possible that this injury left the patient more susceptible to future DVTs as compared to a patient without previous vascular injury?
Expert Witness Response E-000662
The treating orthopedic surgeon should have taken more care with the surgery to reduce the risk of intra-operative damage to the iliac artery. However such an occurrence is a well-known complication of such surgery even for highly skilled surgeons who routinely perform the procedure. The key to any approach in the hip whether anterior or otherwise is to be familiar with the anatomy and to protect the vital structures while gaining exposure to perform the procedure. The artery should have been at all times protected during the procedure. If this was not done then this may represent a departure from the standard of care. Asking for an intraoperative vascular surgical consult is good medicine and may have prevented more serious complications for the patient. An arterial injury would not increase the chance of a deep vein thrombosis in the future and so in my opinion the two events are unrelated. However, DVT is a known complication of total hip replacement due to prolonged immobility in the recovery period. Immobility causes sluggish blood flow which in turn increases the risk of a DVT.