Joe A Shaw PA-C - 6/18/2008

Question
My mother had a total knee replacement. Right after the surgery, the surgeon noted that he coudn't feel her pulse in the dorsalis pedis on her foot. So two other cardiovascular surgeons found that there were was damage to the intimal layer of popliteal artery behind her knee. They put in a Viabahn stent to restore complete blood flow the lower leg after exactly 24 hrs after the initial finding that there was no dorsalis pedis pulse. One of my mother's rehab doctor suggests that the damage probably happened when the orthopaedic surgeon was flexing and extending the knee during the surgery. I haven't asked for the video of surgery yet, but I'll see if I can get one. Do you think there is malpractice here, because one of the things that I find odd here is that no one seems to want to talk about it and the doctors still act like they don't know what happened and have no clue about the future outcome of the stent that they placed in mother's popliteal artery. So is there malpractice, and what else can I do in this situation for my mother?


Answer
Alex,
I doubt there was malpractice just based on the history you gave. You have to remember there is a risk and benefit to any treatment or procedure. Devil's advocate would say, so you didn't want us to bend and flex her knee to make sure the Knee replacement was fitted properly etc...During a knee replacement you have to bend (flex)and extend the knee a certain amount to get the proper fit and size and measurement of installing this large metal joint into place. Even if you could prove that the "damage" was done during surgery I still don't think there is a case..b/c again you are putting a large metal joint into an elderly lady because they were in so much pain to begin with that they could no longer be active..the benefits would be to have a knee that is no longer causing these symptoms etc..the risks could be infection, poor circulation etc..
Now if you discover that they did something out of the ordinary or they were negligent in some way then you can look into that down the road, but you need to see what the outcome is going to be before you can do anything.
Medicine is still a practice..ie the art of practicing medicine. So I'm sure the Dr's are leery about saying oh yeah the stent will solve everything no problems etc..
You have to evaluate it case by case, day by day and see if she is progressing etc...Also every patient is different with different set of risk factors whether its being over wt., smoker, diabetes, sedentary life style, High BP, age etc....
I think you are doing what you can,,you seem to be asking the right questions and letting the Dr's know your concerns