A Shropshire professor was using an “extremely unusual” surgical technique in a failed knee operation in which a devoted father-of-three died, an inquest heard.

Louis Belcuore was undergoing day surgery at Robert Jones and Agnes Hunt Orthopaedic and District Hospital Trust in Oswestry.

The 43-year-old from Morton Bagot in Warwickshire, died during the knee operation on October 20, 2009.

Paul Sutton, orthopaedic surgeon and knee specialist at the Northern General Hospital, in Sheffield, gave evidence yesterday on the second day of the week long inquest.

Mr Sutton said Professor James Richardson, who carried out the operation, should have informed the Medical Device Committee at the hospital of his modifications to surgical equipment.

The inquest heard that Professor Richardson “understood it to be safe” to remove a flexible tip on a Quixil product — applying air pressure — with a needle.

“”I believe on balance his modifications were such that he should have taken it to the Medical Device Committee at his Trust,”Mr Sutton said. “I would expect one of our surgeons to do that.”

He added: “The way Professor Richardson was using air was an extremely unusual surgical technique. No arthroscopic surgeons I have spoken to have used air in this manner.”

Shropshire Coroner Mr John Ellery said Mr Belcuore’s death was most likely caused by an air embolism — a condition caused by gas bubbles in the vessels which carry blood.

Professor Richardson said: “I altered it for the purpose I needed. I understood it to be safe. I made sure a video was supplied and I explained entirely to the Trust how I used the Quixil product.

“The only thing I did particularly differently was use it at a short distance. A needle is such a commonly used item, I simply find it easier to use.

“At the time it did not seem to be a significant modification,” he said.

The hearing continues.