A WOMAN was left to suffer "unnecessary pain and disability" for five years because doctors failed to spot an infection which would eventually cause her hip replacement to collapse, a watchdog has said.

The Scottish Public Services Ombudsman (SPSO) said there was a "repeated failure to carry out appropriate tests" which would have picked up the infection earlier, and criticised medics at NHS Tayside for missing abnormalities detected by X-ray, MRI and CT scans.

The SPSO said this revealed "recurring and systemic failures in care".

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The patient, known only as Ms A, was suffering from severe osteoarthritis when she was admitted to Perth Royal Infirmary in May 2010 for a total right hip replacement using a cementless metal-on-metal hip.

By January 2012, however, she was experiencing severe right hip pain.

MRI, CT and ultrasound scans were carried out, but doctors did not find evidence of a problem with her hip and referred her for physiotherapy instead.

The pain only worsened, however, ruining her ability to walk and carry out everyday tasks.

The SPSO report states: "She had to reduce her working hours due to exhaustion.

"Her social and family life was affected by her lack of energy and her limited mobility. She gained weight and the constant pain affected her mental health.

"Her confidence was affected, as she felt disbelieved or dismissed that something was seriously wrong with her hip joint."

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Further MRI scans in 2015 were also said to have found nothing, followed by X-rays in May 2016 and May 2017 which again she was told "showed nothing of concern".

In June, she attended an annual review where a clinical auditor spotted changes to her hip in the May 2017 X-ray which had not been picked up by doctors.

Ms A was referred to another orthopaedic surgeon.

In August 2017, while still waiting for that appointment, Ms A's symptoms suddenly deteriorated.

X-rays revealed that her hip had experienced a "catastrophic failure" by collapsing at the socket and she was admitted to Ninewells Hospital for emergency surgery.

The orthopaedic surgeon discovered "a deep-seated infection in her right hip joint".

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An independent orthopaedic expert who advised the SPSO said that it was unreasonable that doctors had not identified problems in the May 2017 X-ray.

The expert told the SPSO that the X-ray showed progressive bone loss leading to "definitive loosening of the cup part", and that these changes "were not subtle".

They added that ultrasound and CT scans carried out as early as 2012 had revealed abnormalities in the form of "thickening" of the soft tissues around the implant, which should have been examined further. 

Groin pain, pain when she rotated her hip and pain when she got up from a seated position - reported by the patient in 2012 - were also "specific signs and symptoms consistent with a problem with Ms A's hip replacement", said the adviser.

The report added that "between 2012 and 2017 there was an unreasonable failure to fully investigate Ms A for any right hip infection", despite blood tests showing a persistently high rate of C-reactive protein (CRP) - a marker for inflammation.

The watchdog said Ms A's ordeal was "compounded by NHS Tayside's failure to adequately investigate her complaint".

The health board wrongly came to the conclusion that there were no significant failings in Ms A's care and "missed an opportunity to learn", said the Ombudsman.

The SPSO added: "An earlier diagnosis would not have changed the treatment Ms A ultimately needed, which was a staged hip replacement.

"Also, it would not have changed her long-term outcome.

"I hope this provides some measure of comfort to Ms A now.

"However, the delay would undoubtedly have caused her unnecessary pain and disability over that five-year period.

"I am deeply concerned about the impact this had on Ms A physically, mentally and emotionally."

In light of the case the SPSO has issued a number of recommendations to NHS Tayside, which the health board has said it will act on.

A spokeswoman for NHS Tayside said, “We are taking actions to address the recommendations in the report.”