On Dec. 1, 2009, plaintiff Mary Dorn, 48, a daycare operator in Chico, underwent a total right knee arthroplasty by Dr. Kirk Granlund, after a course of conservative treatment failed to resolve her severe right knee pain. Dorn claimed that she immediately felt severe pain after the surgery and was unable to get around. She claimed she continually reported the severe pain to Granlund for nine months, until finally left his care in September 2010. Dorn claimed that there must have been a malalignment of her patella during the arthroplasty by Granlund and that this resulted in patella baja, or an abnormally low lying patella that is associated with restricted range of motion, crepitations and retropatellar pain. Dorn sued Granlund and the doctor’s practice, Orthopedic Associates of Northern California. Dorn alleged that Granlund failed to properly perform the arthroplasty and failed to diagnose her knee condition during her post-operative care. She also alleged that these failures constituted medical malpractice and that Orthopedic Associates was vicariously liable for Granlund’s actions. The plaintiff’s forensic orthopedic expert opined that Dorn’s knee was malaligned during the subject arthroplasty. Specifically, he opined that too much was cut off the femur during the surgery, causing ligament instability and ultimately resulting in increased height of the joint line in relation to the patella, or patella baja. Plaintiff’s counsel contended that despite the malalignment during the surgery, Dorn’s patella condition was not diagnosed or fixed by Granlund at the time of the first post-operative X-ray on Jan. 6, 2010. Thus, counsel contended that Granlund’s treatment of Dorn fell below the standard of care. Defense counsel argued that the arthroplasty was correctly performed and that Dorn’s failure to complete physical therapy contributed to her problems. Counsel noted that Granlund’s records after the arthroplasty showed that Dorn’s condition had improved initially, but that Dorn attended only an initial physical therapy session and did not complete physical therapy. Defense counsel further contended that when Dorn repeatedly complained of severe pain to Granlund, the doctor ruled out obvious causes, such as component loosening and an infection. As a result, Granlund suggested that Dorn give it time and recommended further physical therapy, which Dorn allegedly refused. Defense counsel noted that Dorn eventually had a revision surgery in October 2010 to put in a larger spacer component, but that she again failed to complete physical therapy due to pain. Counsel further noted that Dorn eventually left her second orthopedic surgeon’s care in January 2011 and had a complete revision with component removal and replacement by a third orthopedic surgeon in January 2012, as well as underwent a manipulation under anesthesia in March 2012. However, defense counsel noted that, once again, only four sessions of physical therapy occurred due to pain. Thus, the defense’s orthopedic surgery expert opined that the alignment of Dorn’s knee was within the acceptable limits during the procedure with Granlund and that Dorn did not have patella baja during Granlund’s care. Instead, the expert opined that Dorn’s patella baja came about over time due to scarring down of the patellar tendon, accentuated by multiple surgeries and failure to complete physical therapy to strengthen the leg. In addition, defense counsel contended that the surgeon who performed Dorn’s final revision surgery backed up the defense’s expert’s opinions., Dorn claimed that she suffered a malalignment of her patella during the subject arthroplasty with Granlund, resulting in patella baja. She claimed Granlund’s failure to recognize her injury post-operatively resulted in two further surgeries, including a revision surgery in October 2010 to put in a larger spacer component, and a complete revision with component removal and replacement in January 2012. She also underwent a manipulation under anesthesia in March 2012. Dorn claimed that despite the surgeries, she continues to suffer intractable pain, and an inability to work or perform activities of daily living. At the time of trail, she was on crutches, using heavy narcotic pain medication and unable to work. Thus, Dorn and her husband claimed that the family daycare and pre-school business failed due to Dorn’s inability to run them. Thus, Dorn sought approximately $9,000 in out of pocket costs for past medical care, $79,000 in past lost income, $942,000 in future medical costs/chore services, and $291,000 in future lost earning capacity. She also sought recovery of damages for her past and future pain and suffering. As a result, plaintiff’s counsel asked the jury to award Dorn over $1 million in total damages. Defense counsel acknowledged that Dorn suffered from patella baja, but contended that the condition developed over time and was not caused by anything Granlund did or did not do. The defense’s expert orthopedist opined that Dorn’s patella baja ultimately occurred due to scarring down of the patellar tendon, accentuated by multiple surgeries and failure to complete physical therapy to strengthen the leg. Thus, counsel argued that Dorn failed to mitigate her damages by completing physical therapy. In addition, defense counsel disputed Dorn’s loss or earnings claim, arguing that Dorn should be able to do sedentary work.