3. Mr A complains Sheffield Teaching Hospitals NHS Foundation Trust performed an incorrect hip surgery on 9 November 2023.
4. Mr A says this has complicated his recovery and he had to undergo further unnecessary surgeries.
5. Mr A is seeking financial remedy.
6. This background is only intended to place the key events related to this complaint in context, not to provide a full, chronological account of everything that happened.
7. Mr A is a 75-year-old man with a history of hip problems. Mr A had a left hip replacement in 2003 and a right hip replacement in 2004.
8. On 7 November 2023, Mr A presented to ED with hip and leg damage after a fall.
9. On 9 November, the Trust performed surgery to repair Mr A’s hip and femur fracture.
10. On 27 December, Mr A presented to ED with leg pain after another fall.
11. On 28 December, the Trust performed a second surgery on Mr A to repair his femur again.
12. On 24 January 2024, Mr A presented to ED with sharp hip pain after bending down to get milk out the fridge. He was diagnosed with hip dislocation and the Trust performed a third surgery to reset Mr A’s hip.
13. On 25 January, the Trust performed a fourth revision hip surgery on Mr A.
17. Before we decide if we should carry out a detailed investigation of a complaint, we look at whether there are signs the Trust has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications anything went seriously wrong.
18. From Mr A’s medical records, we can see he was diagnosed with a periprosthetic fracture of the femur around his right hip replacement after a fall on 7 November 2023.
19. Our adviser said there are no specific guidelines around management of periprosthetic hip fractures. The relevant standard is therefore the GMC’s ‘Good Medical Practice’, which sets out the principles and standards expected of all doctors. Section 15 of ‘Good Medical Practice’ says clinicians should ‘promptly provide or arrange suitable advice, investigations, or treatment where necessary’.
20. In combination with the GMC’s ‘Good Medical Practice’, we will also look at a peer reviewed journal article from the National Library of Medicine on the management of periprosthetic hip fractures, to inform our thinking.
21. The journal article ‘Periprosthetic hip fractures: an update into their management and clinical outcomes’ says ‘Type B is the most challenging category in the treatment algorithm, as there is variability and difficulties in determining whether (a) the prosthesis is loose (B2 subtype) or not (B1 subtype); (b) the bone stock is compromised (B3 subtype), which usually requires advanced revision arthroplasty (joint replacement) techniques’.
Unf 22. From Mr A’s medical records, we can see the Trust performed a revision hip replacement surgery on 9 November. Our adviser said given Mr A had suffered a type B periprosthetic fracture, it was an appropriate clinical decision to perform a revision hip replacement surgery.
23. Our adviser said this in line with ‘Good Medical Practice’. It is also supported by the information in the peer reviewed journal article on the management of periprosthetic hip fracture.
24. We have also considered whether there was any indication Mr A’s subsequent hip dislocation could be caused by the first surgery performed on 9 November. From Mr A’s medical records, we can see on 24 January he suffered a hip dislocation after bending down to get milk out the fridge.
25. Our adviser has reviewed Mr A’s operation notes from 9 November. Our adviser said it was an appropriate surgery, it was considered a success and said there is no indication of any issues that arose during the surgery, which could have caused Mr A’s later hip dislocation.
26. The Orthopaedic Trauma Association’s (OTA) webpage on periprosthetic hip fractures lists hip dislocation as a possible side effect of periprosthetic hip fracture. This could help to explain why Mr A suffered hip dislocation on 24 January.
27. We have also considered Mr A’s view as to whether the fourth surgery performed on 25 January, should have been performed on 9 November.
28. Our adviser said the surgery performed on 25 January, involved changing the lining of the acetabulum (hip socket) to a constrained liner, which helps to prevent further hip dislocations.
29. Our adviser said this type of surgery was not performed on 9 November, as the hip socket was found to be stable and there were no signs of instability at this time. There was therefore no clinical need to change the hip socket or its liner during the initial surgery on 9 November.
30. Having reviewed all the available evidence, there is no indication the Trust inappropriately managed Mr A’s periprosthetic hip fracture. We have seen no indications the Trust has not followed GMC guidelines.
31. We hope we have clearly explained the reasons for our decision and assured Mr A that we only reached it after thorough and careful consideration. We appreciate Mr A has had a distressing experience and we thank him for taking the time to raise his complaint with us.
1. We have carefully considered Mr A’s complaint about Sheffield Teaching Hospitals NHS Foundation Trust (the Trust). We were saddened to learn about Mr A’s injuries, his admissions to hospital, and multiple surgeries.
2. We have decided we will take no further action. This is because we have seen no indications the Trust performed an inappropriate surgery on 9 November 2023. We will go onto explain the reasons for our decision in our statement.