"It is difficult to correlate being back at work as being the cause of his knee problem, as this may have occurred anyway at this stage. However his return to work did seem to precipitate the start of his ongoing symptoms."
"As I have said in the report itself it is difficult to directly correlate the return to work as the cause of Mr Guntrip's ongoing symptoms and as you say on the balance of probabilities the symptoms [of which] the claimant complains I don’t think arose directly from his return to work. The return to work however has seemed to precipitate the symptoms and may have brought the symptoms on sooner than might otherwise have occurred."
"4.1 This work is work that somebody could routinely expect to return to with a well functioning unicompartmental replacement. The stresses involved even with a stiff manual clutch should not pose a problem with a satisfactory replacement. ... 6. There is a temporal relationship between the start of his symptoms and his return to work. It is likely that these would have occurred anyway and were not caused by his return to work."
"The question here is what has actually gone wrong with his knee. Professor Murray clearly thinks there is sufficient evidence here to offer an exploration and I will certainly go along with that. In the absence of infection the early loosening problems would seem to be the main issue here. However, it is certainly not gross. It is not evident on the films although I accept they are somewhat out of date. It could be argued that if this implant was going to come loose it would have done at some stage or other, however, subjecting it to this sort of insult transforms that possibility to a probability. Clearly his employers do not appear to have appreciated this problem."
"Turning to the operative notes by Professor Murray dated02 March 2011 [he] commented that the components of the implant were noted to be secure. The collateral ligament was slack. The medial compartment of the knee could be opened 3-4mm. He noted there was some overhang on the bearing. Evidence of impingement. Osteophytes required removal and once this had been done, full extension could be achieved. A5 bearing was required to get stability."
"Professor Murray makes no comment as to why this situation has arisen. On the assumption that Mr Guntrip was well for 6 months it would suggest that there had been some sinkage of at least the femoral component which had then stabilised causing the continuing problem. As it was well fixed some 5 years down the line that seems to be a reasonable assumption."
"I think on balance here it would suggest that Mr Guntrip's problems start with the bus driving business that we have already discussed in my main report."
"I do regard it as vital that the Court of Appeal supports first instance judges who make robust but fair case management decisions."