In our April 2025 article, Short stem, strong defence, we considered the District Court’s decision in Taylor v Woodgate [2025] NSWDC 89, in which a medical negligence claim arising from a hip replacement and subsequent revision surgery was dismissed. That decision was subsequently appealed. In Taylor v Woodgate [2025] NSWCA 270, the NSW Court of Appeal dismissed the appeal.
District Court decision
The hearing at first instance considered whether the defendant, Dr Woodgate, an orthopaedic surgeon, breached his duty of care in relation to a hip replacement procedure, and a subsequent revision procedure. The plaintiff claimed that Dr Woodgate was negligent in:
- failing to warn him of the risk of complications
- failing to perform the revision procedure to the expected standard, and
- failing to provide him with adequate post-operative management.
The plaintiff failed to establish breach on all five grounds. Weber DCJ found that Dr Woodgate had advised the plaintiff of the risks and benefits of the proposed surgery, as detailed in his clinical notes. His Honour accepted Dr Woodgate’s evidence as to the steps he undertook during the revision surgery, commenting that he 'presented as a very organised, methodical man'.
Weber DCJ also found that Dr Woodgate took a history of the plaintiff’s level of function and activity at each consultation after the revision surgery, which was accurately recorded in his notes.
Further, Weber DCJ accepted the joint orthopaedic expert evidence which concluded that there was no radiological evidence of movement in the stem from August 2011 to 2017.
In addition, Weber DCJ found that, on balance, the plaintiff would have had the same result had a conventional stem been used in August 2010 as he did from the short stem prosthesis.
Judgment and verdict were made for the defendant, and the plaintiff was ordered to pay the defendant's costs.
The decision at appeal
The appellant brought an appeal before the Supreme Court of NSW that was ultimately dismissed. The judgment was handed down on 15 December 2025.
The Court dismissed the appeal with respect to three dispositive questions.
- Was the stem ‘loose’ at the time of the revision surgery?
- Did the stem become loose at some time in the period between the Revision Surgery and 2017?
- Whether, in the period after the Revision Surgery until 2017, an orthopaedic surgeon exercising reasonable care would have detected or investigated whether the stem was loose and recommended further revision surgery?
First dispositive question
It was common ground that radiological imaging on its own was not necessarily conclusive of the question of whether a device is ‘loose’ on its own. The Court therefore looked to the respondent’s evidence of his usual practice, his recollection of the surgery and the surgical report.
The respondent gave evidence about his usual practice to determine whether a stem was loose during the course of a surgery. The joint view of the orthopaedic experts was that the respondent took reasonable steps to make this assessment.
It was also found that had the stem been loose, such steps would have revealed that fact. Since the respondent did not find that the stem was loose during the revision surgery, the Court was satisfied that the stem was indeed not loose at the time of the revision surgery.
Second dispositive question
The Court found that since the radiological evidence was limited, the appellant’s clinical presentation was critical to determining whether the stem was loose.
The Court also found that the appellant had been able to play squash and other sports after the Revision Surgery, which would not have been possible in a patient with a loose stem.
Further, there was an inconsistency between the appellant’s evidence and the respondent’s clinical records which revealed that in his evidence, the appellant downplayed his experienced pain and the extent to which he played squash.
As such, the Court held that the primary judge did not err in his decision that the appellant failed to discharge his onus of establishing that the device was loose.
Third dispositive question
The appellant accepted that if he failed on the second dispositive question, his claim in relation to the respondent’s ongoing management of his hip must fail, and as such this question did not arise. Regardless, the Court formed the view that the expert evidence together with the appellant’s clinical presentation demonstrated that the plaintiff was ‘functioning fine’ and that the respondent could not have been found negligent in failing to recommend further revision surgery.
Implications for you
The Court of Appeal’s decision reinforces several important principles for defendants and insurers defending complex medical negligence claims, particularly those involving alleged implant failure, delayed diagnosis and long‑term post‑operative management.
First, the decision confirms that radiological evidence will rarely be determinative in isolation. Where imaging is equivocal, courts will look closely at contemporaneous clinical records, evidence of the treating practitioner’s usual practice, and the patient’s functional presentation over time. The Court’s endorsement of the primary judge’s approach highlights the forensic value of detailed, contemporaneous notes and clear evidence as to how intra‑operative assessments are ordinarily conducted.
Secondly, the appeal underscores the continued importance of clinical presentation and functionality in assessing both breach and causation. Evidence that a patient maintained a high level of activity over an extended period was central to rejecting the allegation that the prosthesis was loose, and to concluding that further investigation or revision surgery was not required. This serves as a reminder that courts will scrutinise inconsistencies between a plaintiff’s retrospective account and the objective clinical record when assessing credibility and onus.
Thirdly, the decision highlights the strategic significance of joint expert evidence in medical negligence proceedings. The Court’s reliance on the orthopaedic experts’ consensus as to reasonable surgical practice, and the limits of radiological interpretation, illustrates the weight that may be afforded to properly framed joint opinions, particularly where they align with contemporaneous documentation and treating evidence.
Finally, the dismissal of the appeal reinforces the challenges plaintiffs face in establishing negligence in cases involving longitudinal care and delayed intervention, especially where earlier outcomes would not have been materially different.
For insurers and defendants, the decision provides further authority supporting a robust defence where the evidence demonstrates reasonable decision‑making at the time, even in circumstances where a different clinical pathway is ultimately adopted years later.
