Amputation/subsequent prosthetic use in cases of Chronic Regional Pain Syndrome

Sun, 27 Jan 2019

Headline

1. Chris Bright QC and Paul Evans of No5 Chambers, instructed by Laura Harper of Thompsons Solicitors Birmingham, recently acted for a Claimant in an unusual and interesting claim in which a claimant suffering from Complex Regional Pain Syndrome ("CRPS”) underwent an elective left above-knee amputation. The decision to do so was challenged by the Defendant but, following a transfemoral amputation the Claimant had become a successful and active prosthetics user. 

Background

2. The Claimant, a 36-year-old serving West Midlands police officer, suffered a knee injury in a fall in a police station for which liability was admitted. Despite medical and surgical management, the Claimant continued to suffer pain and mechanical problems in the knee, initially developed medial compartment osteoarthritis and unfortunately went on to develop significant CRPS and a psychological reaction, severely restricting his mobility and functioning. Such was his pain that, contrary to a significant body of current thinking in the management of CRPS and in the face of opposition from the Defendant, the Claimant began to explore the potential for amputation.

3. Following the initial instruction of surgical, pain management and psychiatric experts, permission was gained for reports from Dr Sooriakumaran (Rehabilitation) and Mr Jones (Vascular Surgeon) for the Claimant and Professor Hanspal (Rehabilitation) and Professor Atkins (Orthopaedic) for Defendant, to consider the indications for and likely outcome of amputation. The Claimant’s position, as supported by Dr Sooriakumaran and Mr Jones, was that he had capacity and was entitled to make the decision to undergo the surgery, which had a good prospect of significantly improving both his pain and mobility. The Defendant’s position, as supported by Professors Hanspal and Atkins, was that the amputation was contraindicated and unlikely to resolve the Claimant’s pain as the CRPS was likely to return, and would certainly not facilitate prosthetic use.

4. Nevertheless, having undergone psychological and rehabilitation assessment, the Claimant bravely and stoically made a carefully considered and informed decision, supported by a reasonable body of medical opinion, to proceed with a transfemoral amputation.  The surgery was undertaken privately by Mr S Mannion, Consultant Orthopaedic and Trauma Surgeon. The Claimant accepted that by undertaking the amputation that he was not prejudicing the Defendant’s ability to argue at trial that it was an unreasonable step and/or that he was not a suitable candidate for prosthetics. 

Outcome

5. The Claimant progressed extremely well post-surgery, both generally and in that the CRPS did not return as the Defendant had predicted, and underwent a PACE Rehabilitation assessment for prosthetics use, physiotherapy and occupational therapy.

6. The Claimant’s evidence on condition and prognosis via Dr Sooriakumaran was that:-

(i) The Claimant was likely to complete gait training and to achieve SIGAM grade E mobility within another 6 months. He would supplement prosthetic mobility with wheelchair use and, with some adjustments, gain independence for personal hygiene and lighter housework. He would need assistance for heavy and awkward housework, DIY and gardening. He has the capacity for sedentary part time work, with suitable support/facilities, but would retire by aged 60.  He requires single level accessible adapted accommodation and is likely to maintain this until aged 60-65.

(ii) From 65 there is likely to be a deterioration in function to SIGAM grade D, with a consequent increase in wheelchair dependence, care and assistance for daily living.

(iii) From aged 75 to end of life the Claimant would continue to use his prosthesis for walking limited distances on level ground with more supportive walking aids - SIGAM C mobility. He would predominately use a powered wheelchair for outdoor mobility, would need a hoist or roll in/roll off access for a vehicle and would need a care package.

Settlement

7. Following two failed RTSM during the course of the litigation, at a third RTSM the claim was settled for a lump sum - the Claimant’s preference - of 2.6m with the Defendant ultimately accepting that, on the balance of probabilities, the CRPS would not recur and that the Claimant would continue to be a successful prosthetics user

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