Misdiagnosis in Orthopedics: From Hip Avascular Necrosis to Unnecessary Spinal Fusion

Avascular necrosis of the femoral head, yet underwent total lumbar fusion?

In October 2022, I experienced sudden pain in my left lower limb and groin, along with a sensation of leg length discrepancy and limping.
I went to the neurosurgery department at Tainan Medical Center, where I was immediately scheduled for surgery to perform minimally invasive fusion of L1, L2, L3, L4, L5, and S1.
After the surgery, I continued to experience pain and limping, and despite regular follow-up visits, there was little improvement.
During this time, I was asked if I wanted to have the screws removed, but I had many questions about why that would be necessary.
It wasn't until my follow-up appointment in December 2023 that I asked the doctor why there had been no improvement.
The doctor ordered an X-ray of my hip joint, which revealed stage IV avascular necrosis of the femoral head, and advised me to consult an orthopedic specialist.
I then visited the orthopedic department at Kaohsiung Medical University, where the orthopedic surgeon noted that the indications were sufficient to suspect an issue with the hip joint.
However, the neurosurgeon had not conducted a comprehensive evaluation before proceeding with the lumbar surgery, which seemed quite strange.
Recently, I underwent total hip arthroplasty at Kaohsiung Medical University, and my limping and groin pain have resolved.
However, I am now uncertain about how to manage the lumbar spine issue, and I have heard from other doctors that lumbar fusion can lead to complications in the coming years.
Additionally, in this situation, can the patient seek legal recourse?

Wu, 70~79 year old female. Ask Date: 2024/03/22

Dr. Shen Boquan reply Orthopedics

There are many possible causes of discomfort and pain in the lower limbs, including muscle pain, joint inflammation, and lumbar nerve compression commonly known as sciatica.
Avascular necrosis of the femoral head is also a possibility.
Sometimes, these conditions can occur simultaneously.
The physician will discuss your symptoms with you and determine the appropriate management.
If you have any concerns or questions, please discuss them further with your attending physician or surgeon, as they are more familiar with your condition.
Wishing you good health, Shen Boquan.

Reply Date: 2024/03/22

More Info

Misdiagnosis in orthopedics, particularly in cases involving complex conditions like avascular necrosis (AVN) of the hip, can lead to unnecessary surgeries and prolonged suffering for patients. Your experience highlights the critical importance of accurate diagnosis and comprehensive evaluation before proceeding with surgical interventions.

In your case, the initial presentation of left lower limb pain, groin pain, and a sensation of leg length discrepancy led to a surgical decision to perform a spinal fusion involving multiple lumbar vertebrae. This decision appears to have been made without a thorough assessment of the hip joint, which ultimately turned out to be the source of your symptoms due to advanced AVN. The fact that your symptoms persisted post-surgery indicates that the underlying issue was not addressed, and the surgical intervention may have been unnecessary.

Avascular necrosis of the hip occurs when blood supply to the femoral head is compromised, leading to bone death and subsequent joint dysfunction. The symptoms typically include groin pain, which can radiate to the thigh or knee, and may be accompanied by a limp. In advanced stages, as you experienced, the pain can become debilitating, and joint replacement may be necessary to restore function and alleviate pain.

The misdiagnosis and subsequent unnecessary spinal surgery raise several important points regarding patient rights and medical accountability. Patients have the right to seek a second opinion, especially when symptoms persist despite treatment. In your case, it seems that the second opinion from an orthopedic specialist was crucial in identifying the true nature of your condition and providing appropriate treatment.

Regarding the management of your lumbar spine post-surgery, it is essential to consult with a spine specialist who can evaluate the outcomes of the fusion surgery and determine if any further interventions are necessary. While some patients do experience complications or residual pain after spinal fusion, many can manage their symptoms effectively with physical therapy, pain management strategies, and lifestyle modifications.
It is also worth noting that spinal fusion can lead to adjacent segment disease, where the levels of the spine adjacent to the fused segments may experience increased stress and develop issues over time. This is why ongoing monitoring and a proactive approach to spinal health are essential.

As for your question about patient rights, if you believe that the initial misdiagnosis and subsequent surgery caused unnecessary harm or suffering, you may have grounds for a medical malpractice claim. It is advisable to consult with a legal professional who specializes in medical malpractice to discuss your situation in detail. They can help you understand your rights and the potential for pursuing compensation for any damages incurred due to the misdiagnosis and unnecessary surgery.

In conclusion, your experience underscores the importance of thorough diagnostic evaluation in orthopedic cases, particularly when symptoms are complex and multifactorial. It is crucial for patients to advocate for themselves, seek second opinions when necessary, and ensure that all potential diagnoses are considered before undergoing surgical interventions. Your journey towards recovery may involve addressing both the outcomes of the spinal surgery and the management of your hip condition, and with the right support, you can work towards regaining your quality of life.

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