In December 2024, a patient from the 9th arrondissement of Marseille heads off to register for a rather routine procedure. On the program: the removal of a hip resurfacing and the installation of a total prosthesis. But what was supposed to be a new beginning ends with a leg that is ultimately shortened. For what ? After the operation, the patient’s condition deteriorated. When it turned out to be affected by a nosocomial infection, the surgeons had no choice but to resort to surgical revision. A corrective operation which resulted in a “shortening of the left leg”.
A serious and difficult to treat infection
Medical error or last chance operation? Dr Gérald Kierzek, emergency doctor, recalls that an infection on a prosthesis is “a very serious complication”.
“The responsible bacteria form a biofilm, that is to say a thin protective layer on the prosthesis, which makes them almost impossible to eliminate with antibiotics alone.
To cure the patient, surgical revision is therefore necessary. This new operation consists of removing the infected prosthesis, then thoroughly cleaning the tissues (bones and muscles) in order to remove all traces of the infection.
“All infected material and all necrotic tissue must be removed”explains Dr. Kierzek.
Often unavoidable anatomical consequences
Unfortunately, during removal of the denture and cleaning, some of the bone may be lost, either because it is removed with the denture or because it has been destroyed by the infection itself.
The soft tissues (muscles, ligaments) around the hip can also be damaged, weakening the structure of the hip.
“Leg shortening is obviously not the goal of surgery,” says Dr. Kierzek. “It is an unwanted, but often unavoidable, consequence of the actions necessary to eradicate the infection.”
Once the infection is under control, the surgeon must then implant a new prosthesis. But due to bone loss and destroyed tissue, the initial anatomy is often disrupted.
“In some cases, the surgeon must reassemble the femur to obtain proper tension of the remaining muscles and ligaments. This mechanically shortens the leg, but ensures a stable hip”continues the doctor.
In other words, it is a surgical compromise: a slightly shorter leg is better than an unstable prosthesis which risks permanently dislocating.
A case that revives the debate on hospital infections
This case, however, highlights the complexity of treating nosocomial infections, particularly when they occur on joint prostheses.
It also recalls the importance of prevention, vigilance and postoperative follow-up in public hospitals. Even in optimal conditions, certain rare complications unfortunately remain difficult to avoid, as Dr Kierzek points out: “These situations remind us that in medicine, certain consequences are not the result of a fault, but of the anatomical cost sometimes necessary to save a patient.”
The now disabled (but alive!) patient, however, took legal action last July to request a medical assessment and determine whether he could obtain compensation.