The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

3. Miss E complains the Trust discharged her in March 2022 without telling her. Then when her GP referred her back to the Trust, it discharged her again even though it had not diagnosed her or resolved the ongoing problem with her knee.

4. Miss E says because of this she was left in pain. She says the Trust has not acted professionally and this caused her distress.

5. Miss E would like the Trust to accept what it got wrong, apologise and make a financial payment to her for the distress she has experienced.

6. Miss E went to the Trust on 18 July 2019 for a total left knee replacement. The operation notes say the operation went smoothly.

7. Miss E had many appointments at the Trust from 20 December 2019 to 21 July 2022 because she was experiencing pain and discomfort.

8. Miss E saw a knee specialist on 22 September 2021. They agreed to refer her to a consultant radiologist for an ultrasound guided injection. The knee specialist arranged a review for six months later. The consultant radiologist gave the injection on 26 November.

9. A bone and muscle specialist saw Miss E on 17 March 2022. They recorded that previous images showed she had a large popliteal cyst (fluid filled swelling at the back of the knee) before the operation and this was still there. They arranged another ultrasound guided injection for 10 June 2022.

10. Miss E’s GP wrote to the knee specialist on 6 July 2022 asking for an appointment because she still had pain in her left knee.

11. They saw Miss E on 21 July 2022. This was as a new patient as they had discharged her from the clinic before. Their clinical notes said the position was unchanged - the problems she had before surgery were still there despite a successful knee replacement. They said the best course of action would be to leave it and if her symptoms got worse they would review Miss E again.

The Trust did not tell Miss E it had discharged her from its service on 17 March 2022

15. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and we think the Trust got something wrong, but we cannot say it had a negative impact on Miss E.

16. There are no specific guidelines on when a Trust should discharge a patient after they have had a knee replacement. Our adviser says this is the decision of the consultant. If they feel there is nothing more they can offer in terms of treatment, it is appropriate for them to discharge the patient. We do not think there was anything more the Trust could offer Miss E at this time.

17. In the letter from the knee specialist to Miss E’s GP after the appointment on 17 March 2022, there is nothing to suggest they had discharged Miss E. It is not clear from the clinical notes if they told Miss E she would not be routinely seen after this appointment. We can see why Miss E did not know she had been discharged and thought she would be seen again.

18. Our adviser says they should have told Miss E and her GP that they were referring her for another injection but would not see her again unless there were other problems.

19. We can see how this was frustrating for Miss E when she found out later. To ask the Trust to put this right, we would need to see how not doing this affected Miss E. Our adviser says the impact of this was minimal because Miss E’s GP referred her back when she had ongoing pain. She saw the specialist again and he arranged for another injection. If they had kept Miss E under review, her treatment would not have been different. We hope this gives Miss E some reassurance that her discharge did not have a negative impact on her treatment.

The Trust discharged Miss E when it had not diagnosed or resolved her ongoing knee problem

20. In the appointment on 22 July, the knee specialist noted they agreed with Miss E that the best course of action would be to leave the knee and if her symptoms got worse, they would review her. But they did not think they could offer any more treatment. It seems clear they discharged Miss E at this time.

21. The BOAST guidance gives recommendations for the management of patients with problematic knee replacements. It says it is recognised that ten to 20% of patients report pain, stiffness, or unhappiness after surgery.

22. It says second opinions are encouraged, as well as regional referrals to specialist units in more complex cases and in cases of diagnostic uncertainty.

23. Our adviser says Miss E’s clinical notes show the Trust followed the guidance appropriately. Miss E was seen in a complex knee clinic and her care was discussed with colleagues. They also referred Miss E for a second opinion.

24. The guidelines say it is recognised that with some patients no specific cause for their problem will be found. Each unit should have a pathway for management, which may involve pain services, physiotherapy or other specialist teams. Our adviser says Miss E’s records show the consultants were unable to find a specific reason for her pain and followed the guidelines appropriately. The assessment was in line with the guidance as it involved a multidisciplinary team approach (speaking with colleagues from different areas of medicine) and making a referral for a second opinion.

25. We have not seen any sign of a failing when the Trust discharged Miss E in July 2022.

26. We understand it is very frustrating and worrying for Miss E that the Trust could not diagnose or resolve her knee pain. It seems this is one of the unfortunate times when that was not possible, despite all the correct follow up. We appreciate the impact Miss E’s pain has had on her and how difficult things have been for her. We hope our decision reassures her she is not in this position because the Trust did anything wrong or missed opportunities to make things better for her.

1. We have carefully considered Miss E’s complaint about The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (the Trust). We are sorry to hear her concerns about the treatment the Trust gave her and that she feels it discharged her when it had not resolved her problem with her knee. We understand Miss E feels the Trust has not acted professionally by discharging her.

2. We have seen no sign that anything went seriously wrong because the Trust’s treatment seems to have been in line with guidance. We recognise the Trust should have told Miss E it had discharged her from its care on 17 March 2022. But, we cannot see this had an impact on the care the Trust gave her.