AAOS Board Considers Grievances Filed under the Professional Compliance Program

At its meeting on July 21, 2025, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered a grievance filed under the AAOS Professional Compliance Program. The following action was taken: 

Thomas M. DeBerardino, MD
San Antonio, Texas
Expulsion

A grievance alleging violations of the Standards of Professionalism on Orthopaedic Expert Opinion and Testimony was filed against Dr. DeBerardino. The grievance was based on statements made by Dr. DeBerardino in deposition testimony he provided while serving as an expert in a medical liability lawsuit. 

The patient in the underlying case was a woman, aged 68 years, who presented with right chronic knee pain. The patient had a knee arthroscopy for a meniscal tear 10 years prior, as well as a cortisone injection, a course of Hyalgan injections, and physical therapy. Her medical history included a spinal lesion diagnosed 30 years prior that caused weakness with atrophy on the right side. The patient had a BMI of 33 and walked with a cane. Examination of the right knee showed moderate crepitation with range of motion, and passively, her right knee hyperextended 10 degrees. Imaging studies showed dysplasia of the proximal tibial plateau, and mild-to-moderate degenerative changes of the tibial femoral joint and patellofemoral compartment. The surgeon discussed total knee arthroplasty (TKA), including a prolonged rehabilitative course given her right-sided weakness, as well as her tendency for hyperextension, and, depending on the anatomy and ACL status, that various prosthetic implants may be needed. The patient underwent a right TKA for which an anterior implant with a moderate level of constraint was used without complications. At three weeks post-op, she had a well-healed incision, full extension, and could flex to 110 degrees. She subsequently had an injury where she threw out her back, and activity was limited due to pain in the back and knee. The patient started to develop hyperextension of the right knee during ambulation to compensate for her leg weakness. After conservative treatment with physical therapy and orthotics, the patient underwent a revision to a constrained, hinged TKA a year later. 

After thorough consideration, the Committee on Professionalism Grievance Hearing Panel ( COP) and Judiciary Committee (JC) (collectively, the Committees) concluded that Dr. DeBerardino violated Mandatory Standards Nos. 2, 3, and 4. 

In the opinion of the Committees, Dr. DeBerardino violated Mandatory Standard No. 2 in several instances during his deposition by providing testimony that was neither fair nor impartial:

• He testified that the grievant should have utilized a highly constrained and/or hinged implant for this patient due to the patient's comorbidities, including neuromuscular disease, recurvatum, and instability. In his deposition, Dr. DeBerardino was asked whether this case involved “a complicated patient.” Dr. DeBerardino responded, in part:
  
  
  • "[I]n the literature the combination of recurvatum instability and a neuromuscular compromise basically dictates that you’re going to use a constrained and/or hinged prosthesis to help mitigate against the known complication of progression of disease, which is hyperextension and hyperinstability or mobility which dooms a prosthesis because if it sees the regular forces, it’s doomed to get loose and then to get infected.” [emphasis added]

• Dr. DeBerardino was asked about the grievant’s discussion with the patient and referred to the grievant’s notes about the patient’s hyperextension, options to consider and what they may discover intraoperatively. The attorney read from the grievant’s medical note which said “[t]he patient] understood that rehab and physical therapy may be somewhat prolonged compared to normal given her right-sided weakness involving upper and lower extremities. Given her hyperextension, we may need to consider an anterior constrained prosthesis. Much will depend upon the bony and ligamentous anatomy that we discover intraoperatively and whether or not her anterior cruciate ligament is intact or deficient. We also need to consider the possibility of PCL rupture as well and potentially use a posterior stabilized implant.” Dr. DeBerardino responded that it was “a good discussion, but it’s not fully pertinent to her case.” He continued: 
  
  
  • “The more pertinent things to discuss would have been the literature says that even if you're stable at time zero, your disease process tells us that a standard primary total knee with or without a change up in the anterior poly is going to go on to an early failure, loosening and hyperextension.
    
    “...I mean, I didn’t look, but I’ve never heard anyone say you should do a standard total knee that’s not highly constrained or hinged in this subset of populations. It’s not the run-of-the-mill, I mean, as we’ve alluded to.
    
    “She’s got two big elephants in the room, the paresis and weakness and the already subtle but present instability pattern.
    
    “The literature says that will get worse if you do a standard total knee that’s not highly constrained or hinged.” 
    
    
• Dr. DeBerardino was asked to describe how the grievant deviated from accepted medical standards in his treatment of the patient. Dr. DeBerardino responded in part: 
     
  • “... preoperatively is there was a lack of understanding … of the gravity of the importance of her chronic neuromuscular disease. It was mentioned as though she had hypertension [sic]. And hypertension [sic] doesn’t affect the outcome of the total knee, but a chronic 25-year history of weakness and neuromuscular disease always affects the outcome of a standard total knee to the effect that it causes a very high rate of early failure and the need for appropriate revision surgery.” 

In the opinion of the Committees, the above testimony was neither fair nor impartial. Dr. DeBerardino’s assertion that the use of a highly constrained, hinged component for this patient failed to fairly represent the practice behavior of the orthopaedic community. The Committees felt that contrary to Dr. DeBerardino’s testimony, a fully constrained or hinged component is rarely used in a primary situation given the many associated risks it carries. 

With regard to Mandatory Standard No. 3, the Committees found that Dr. DeBerardino failed to demonstrate sufficient knowledge of the standard of care relevant to this case and failed to evaluate the medical condition in the context of care delivered. Testimony considered by the Committees included the following: 

• When asked “How many constrained, hinged total knee replacements have you done in your career?” Dr. DeBerardino responded,
   
  • “I have not solely done any in my career, actually. I have helped with many because these are complex soft tissue issues, not only loss of bone substrate, but I’m often consulted in helping to manage these patients surgically to see if there’s anything we can do in conjunction with or in place of or in conjunction with a rotating constrained hinged knee, arthroplasty, either primary in younger people; sometimes these are done primarily now.”

Further, he was asked how many times he “consulted or helped with” a constrained, hinged total knee replacement. In reply, Dr. DeBerardino said, “I’ve been here four-and-a-half years now – is that true – four years and a little bit. I think I’ve consulted on maybe ten.” 

• Dr. DeBerardino was questioned about the medical literature supporting his opinion, as follows:
  
  
  • Q: “Okay. One of the other production requests we had was with regard to any and all articles, texts, journals, medical literature that you are relying upon for your opinions in this case. And since nothing was produced to us, is it fair to say that you’re not relying on any medical literature, articles, textbooks, chapters for your opinions in this case?”
    A: “Not specifically by name, no. Just in general.”
  • Q: “But as you sit here this afternoon, on [date], you can’t cite any particular article, text or medical literature that you’re relying upon?”
    A: “No, not – I’m not going to cite by specific reference or PubMed reference any specific journal, article or book chapter.”

While Dr. DeBerardino did not produce or name any specific journal, article, or chapter in connection with his deposition, he did submit a number of articles in connection with this grievance. Of the 14 articles he submitted, the majority were published after this patient’s surgery and would not have been available to or known by the grievant. Others support a treating surgeon’s consideration of a hinged or constrained total knee in light of the clinical situation but did not mandate its use. Several of the articles published prior to the patient’s surgery described treatment of a neuropathic joint. There was no indication in the record that this patient had a neuropathic joint. Finally, several articles on recurvatum were supportive of the treatment provided by the grievant.

For these reasons, the Committees concluded that Dr. DeBerardino failed to demonstrate sufficient knowledge of the standard of care relevant to this case and failed to evaluate the medical condition in the context of care delivered, in violation of Standard No. 3.

With regard to Mandatory Standard No. 4, the Committees concluded that Dr. DeBerardino condemned performance that falls within the generally accepted standard of care. Testimony reviewed by the Committees included the following:

• At deposition, Dr. DeBerardino was asked how the grievant deviated from accepted medical standards in his treatment of the patient. He answered that,
  • “An inappropriate, inadequate preoperative workup was rendered vis-a-vis no long-standing films were obtained to better ascertain the degree, nature and localization of the underlying instability pattern.” 
    
    
• When asked about the presence of hyperextension on x-ray images, he answered as follows: 
  • “[I] wouldn’t expect to see hyperextension on a passive, nonstress X-ray, but I didn’t appreciate any because it wasn’t on an appropriate long-length film to which you could legitimately cast recognition or lack thereof of any hyperextension or moment arms of vectors or total limb alignment. In fact, I never saw any long-length films.”
    
    
• He was asked “[f]rom your knowledge of orthopedics and from your conversations with your colleagues, approximately what percentage of total knees go on to have revisions?” Dr. DeBerardino replied: 
  • “So anywhere from 2 to 50 or more percent’s documented in the literature, and it depends on who you work on.”
    
    
• When asked about any changes to his opinion, Dr. DeBerardino replied: 
  
  • “Well, they aren’t really new opinions. They’re caveats to existing opinions. My opinion hasn’t changed. 
  • “My opinion is that the wrong patient was operated on by the wrong surgery with an expected bad outcome.” 

The JC concurred with the COP that, in the orthopaedic community, it is rare to use a fully constrained or hinged component in a primary situation, even in a patient with some neuromuscular weakness, because there are also risks and benefits associated with a constrained, hinged implant. As such, each surgeon must weigh the risks and benefits while using his or her best judgment. As to Dr. DeBerardino’s opinion that the wrong surgery was performed and that the absence of long-length films were a deviation from the standard, the Committees found such testimony was not supported by the facts and he condemned care that fell within the generally accepted practice standards and was therefore in violation of Mandatory Standard No. 4.

After thorough consideration, the AAOS Board of Directors upheld the determinations of the JC that Dr. DeBerardino violated Mandatory Standards Nos. 2, 3, and 4. The Board also considered the two prior grievances filed against Dr. DeBerardino each of which resulted in a one-year suspension. The Board of Directors therefore voted to expel him from AAOS membership.