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In early 2011, Stephen Taylor’s left hip was rebuilt with a MSA Size 2 femoral stem designed to sit snugly in the femur.
By June 2011 imaging showed change: the stem had shifted inwards (into ‘varus’) with X-Rays showing a gap between the stem and the bony material (‘radiolucency’).
Surgeon Ian Woodgate conducted revision surgery on 30 August 2011 but did not replace the stem. According to the operation report written by the assistant and checked by the surgeon, the “stem [was] not loose.”
A further revision was eventually recommended and a surgery to implant a conventional stem occurred in 2019. That stem also moved inwards (into ‘varus’).
Taylor sued Woodgate for negligence in relation to the first revision surgery for failing to identify that the stems were in fact loose.
Radiologist, Professor Ken Thomson – engaged on behalf of Taylor – swore that the radiolucency “can only be explained by loosening”.
Orthopaedic experts, Stephen Doig and Michael O’Sullivan who were called by the surgeon’s insurer, on the other hand insisted that “lucency” should not be equated with actual looseness as isolated lucencies can exist around a stable stem.
They also swore that testing stability of the stem in the manner done in the first revision surgery was a reasonable means to see if it was loose: “if the stem moved, it was loose; if it didn’t, it had likely subsided into a new, stable position”.
Primary judge Robert Weber SC DCJ accepted Woodgate’s evidence on both practice and recollection and put weight on the contemporaneous operative note.
He concluded the surgeon took reasonable steps to test stability which test revealed the stem to have been stable.
Taylor also argued that Woodgate had been negligent in not recommending a further revision before 2017.
This was against a background of him being fit and active playing A grade style squash — sometimes three to four hours at a time involving “running, cutting and pivoting”— plus other vigorous activities across 2012–2017 .
Such history of high level performance neither squared with a definitely loose femoral stem nor ought to have alerted the surgeon to any potential prosthesis stability issues.
The surgeon was entitled – on the judge’s view – to act on the patient’s history of high functionality and thus there was no breach in having not recommended a further revision before 2017.
On appeal, the patient contended the primary judge failed to sufficiently take into account the radiologist’s evidence of radiolucency equating to looseness and to properly weigh his expertise against the opinions of the orthopaedists.
The appeal judges found no error in Judge Webber’s approach or reasoning. They agreed the evidence established that radiology alone was never conclusive and that on the history of multi-hour squash tournaments, no inference of stem looseness could have reasonably been drawn.
His appeal was dismissed.
Taylor v Woodgate [2025] NSWCA 270 Harrison CJ McHugh JA & Free JA, 15 December 2025
Categories: Medical Negligence