The Question: I had a knee replacement one year ago and am still in considerable pain. It turns out the bottom portion of the replacement is loose and needs to be replaced. I wasn't able to do any activities all summer and am now faced with the possibility of having to go through the whole thing again. I have to pay for physiotherapy and outrageous hospital parking fees. What recourse do I have?
The Answer: Loose hardware in the knee sounds ominous, especially since you have already lost so much time trying to convalesce from the first operation. It's not your fault, yet you alone have to suffer the consequences. Problem is, I'm not sure this is any one's fault and that makes the issue of recourse tricky to reconcile.
No matter how well the knee operation was performed or how normal the X-ray looks, about 10 to 20 per cent of patients will continue to experience pain afterward. Few are candidates for a revision as pain is not enough to warrant surgery, according to Bas Masri, professor and head of the orthopedics department of the University of British Columbia and Vancouver Acute Health Services.
"I tell all my patients, 80 per cent are ecstatic with the outcome, 10 per cent are happy but not ecstatic and 10 per cent are not happy at all," according to Dr. Masri, who does 350 hip and knee replacements a year and 150 revisions.
I don't want to sound like an apologist for a surgery that did not take but I am persuaded by Dr. Masri who points out: "loosening is not necessarily medical misadventure because it happens in 1 per cent of cases."
Knee revisions are typically done years – even a decade or more later – due to parts coming loose, wear and tear or instability. The operation replaces the damaged part or the entire implant. Why yours failed so soon is not clear.
"Medicine is not perfect by any means. Even when we're fixing a machine, which is purely mechanical, it doesn't work 100 per cent of the time," Dr. Masri said in a telephone interview from Vancouver. "Just imagine trying to fix a human being where it's a biological system; you're not going to get a perfect result every single time."
During a knee replacement, joints are cemented into position or in some cases, bone is expected to grow into the surface of the implant. Either way, the implant was fixed to the bone. A knee revision is complex surgery and what you really need to do is ensure you have an expert in revision surgery as you need the best outcome possible.
As for recourse, you could consult with a medical malpractice lawyer to see if you have a case, in which you would have limited time to launch an action. You could visit patient relations at the hospital and see if they can wrangle you a deal on parking. Ultimately, you may be stuck paying for physiotherapy and parking again, and have to chalk it up to one of those miserable life experiences.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.