Failure to investigate and treat infection after total knee replacement, leading to above-knee amputation

Abstract

The claimant underwent left total knee replacement surgery for osteoarthritis in November 2007. He had a number of pre-existing health problems, including type II diabetes, psoriasis and diverticulitis. He had previously undergone a successful replacement of his right knee. Surgery proceeded without complication, but within three to four days the wound began to bleed, opened up, and on 13 December 2007,he attended A&E. The wound was red and painful. A swab was taken and he was given Flucloxacillin. No instruction was given for him to telephone for results. The lab reported Group B Streptococcus that was sensitive to flucloxacillin but at very high doses and recommended changing to amoxicillin. He was not informed of the result, and no change was made to the antibiotics. His condition continued to deteriorate and on 22 December 2007, he was admitted as an emergency. He underwent open debridement, wash out and liner exchange on 22 December 2007, and it was confirmed the infection was ‘as before’ and also present in his blood stream, so he had Group B streptococcal septicaemia. The standards of hygiene in the hospital were very poor, with dirty dressings on windowsills, clean sheets put on top of soiled sheets, and empty hand-sanitizer bottles. Following discharge and review, it was decided the implant needed to come out, and he underwent firststage revision surgery on 1 February 2008. Tissue samples grew coagulase negative staphylococcus, but no Group B strep. He was given IV vancomycin for two weeks and oral linezolid for three weeks. The claimant was discharged in a leg splint and was significantly disabled in his home, which is a Victorian terraced house built on four levels with an upstairs bathroom. He was effectively confined to two rooms downstairs. He underwent second stage of revision surgery on 23 May 2008 and was prescribed prophylactic Cefuroxime peri-operatively, but no intra-operative samples were taken for microscopy and culture. A wound swab taken on 27 May 2008 grew coagulase negative staphylococcus, the same organism found at the time of the first-stage revision surgery, but no further intravenous antibiotics were prescribed. The claimant was discharged on 26 May 2008 with the wound still oozing; it continued to discharge and he was re-admitted on 29 May 2008. A wound swab