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Chang KC, Hershfeld BE, White PB, Cohn RM, Mont MA, Bitterman AD. Knee'd to Know Basis: Informed Consent in Total Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:1-5. [PMID: 37821014 DOI: 10.1016/j.arth.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/30/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
Informed consent is the process by which a medical provider explains the benefits, risks, and alternatives to a proposed medical intervention. It is a crucial part of maintaining patient autonomy and is particularly important in the context of elective surgical procedures, such as joint arthroplasty. The goal of this article is to review the topic of informed consent in the context of total joint arthroplasty. In this review, we discuss informed consent in general, considerations for informed consent in general arthroplasty procedures, and special 12 considerations for both hip and knee arthroplasty.
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Affiliation(s)
- Kevin C Chang
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington New York
| | - Benjamin E Hershfeld
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury New York
| | - Peter B White
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington New York
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington New York
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York; Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington New York
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Megalla M, Imam N, Bukowiec L, Coban D, Malik M, Grace ZT, Kohan EM, Alberta FG. Medical malpractice litigation after total shoulder arthroplasty: a comprehensive analysis based on the Westlaw legal database. J Shoulder Elbow Surg 2023; 32:539-545. [PMID: 36252787 DOI: 10.1016/j.jse.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Orthopedic surgery is one of the most common subspecialties subject to medical malpractice claims. Although total shoulder arthroplasty (TSA) is associated with favorable patient outcomes and relatively low complication rates, surgeons performing this procedure may be subject to malpractice litigation leading to significant economic and psychological burden on the provider. The purpose of this study is to characterize and describe malpractice claims against orthopedic surgeons performing TSA using the Westlaw legal database. METHODS The Westlaw legal database was queried for all cases related to TSA using the terms "malpractice" AND "shoulder replacement" OR "shoulder arthroplasty." Cases were excluded if the defendant was not an orthopedic surgeon, the procedure involved was not a TSA, or if the patient was a minor. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were analyzed to determine common factors that lead plaintiffs to pursue legal action. RESULTS Thirty-five TSA cases were identified that met inclusion criteria. The mean plaintiff age was 55 years with 63.6% female. The most common category of negligence alleged was intraoperative error, which occurred in 25 claims (71%). The most common types of damages incurred were nerve injury (23%), functional limitation (20%), and infection (17%). Overall, 27 cases (77%) resulted in a defense verdict. Four cases (11%) resulted in settlements and 4 cases (11%) resulted in plaintiff verdicts. The average inflation-adjusted monetary award in these cases was $1,619,919 (standard deviation, $1,689,452). DISCUSSION This study provides a comprehensive summary of malpractice claims and associated outcomes in TSA. Given the rapidly increasing rate of TSA in the United States and the burden of associated malpractice claims, understanding potential legal implications of TSA is of great value to orthopedic surgeons. Intraoperative error was the category of negligence cited most commonly in TSA malpractice claims. Nerve injury, functional limitation, and infection were the most commonly cited specific damages. These findings highlight the need for orthopedic surgeons to educate patients regarding potential postoperative complications while continuing to focus on minimizing their occurrence.
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Affiliation(s)
- Martinus Megalla
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Nareena Imam
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Lainey Bukowiec
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Martin Malik
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Zachary T Grace
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Eitan M Kohan
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Frank G Alberta
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Salimi M, Heidari MB, Ravandi Z, Mosalamiaghili S, Mirghaderi P, Jafari Kafiabadi M, Biglari F, Salimi A, Sabaghzadeh Irani A, Khabiri SS. Investigation of litigation in trauma orthopaedic surgery. World J Clin Cases 2023; 11:1000-1008. [PMID: 36874422 PMCID: PMC9979292 DOI: 10.12998/wjcc.v11.i5.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.
AIM To review the cases of medical complaints in orthopedic patients who had been involved in a traumatic accident.
METHODS A retrospective multi-center review of trauma orthopaedic-related malpractice lawsuits from 2010 to 2021 was conducted utilizing the regional medicolegal database. Defendant and plaintiff characteristics along with fracture location, allegations, and litigation outcomes were investigated.
RESULTS A total of 228 claims referred to trauma-related conditions with a mean age of 31.29 ± 12.56 were enrolled. The most common injuries were at hand, thigh, elbow, and forearm, respectively. Likewise, the most common alleged complication was related to malunion or nonunion. In 47% of the cases, the main problem that led to the complaint was the inappropriate or insufficient explanation to the patient, and in 53%, there was a problem in the surgery. Eventually, 76% of the complaints resulted in a defense verdict, and 24% resulted in a plaintiff verdict.
CONCLUSION Surgical treatment of hand injuries and surgery in non-educational hospitals received the most complaints. The majority of litigation outcomes were caused by a physician’s failure to fully explain and educate the traumatic orthopedic patients and technological errors.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopaedic Surgery, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | - Mohammad Bagher Heidari
- Department of General Surgery, Kermanshah University of Medical Sciences, Kermanshah 71384333608, Iran
| | - Zohre Ravandi
- Student Research Committee, Kermanshah University of Medical Sciences, Shiraz 7138438756, Iran
| | | | - Peyman Mirghaderi
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran 714356743, Iran
| | - Meisam Jafari Kafiabadi
- Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 715643498, Iran
| | - Farsad Biglari
- Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 715643498, Iran
| | - Amirhossein Salimi
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd 719167534, Iran
| | - Amir Sabaghzadeh Irani
- Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 715643498, Iran
| | - Seyyed Saeed Khabiri
- Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 715643498, Iran
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Litigation after primary total hip and knee arthroplasties in France: review of legal actions over the past 30 years. Arch Orthop Trauma Surg 2022; 142:3505-3513. [PMID: 34697655 DOI: 10.1007/s00402-021-04228-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Since the law of March 4, 2002, several modifications have impacted medical practices and their medico-legal implications. In case of an infectious complication not related to a fault of the practitioners (surgeons, anesthetists), the patient has the right to compensation assumed by the care structures. Moreover, the lack of preoperative information is no longer just a failing of the ethical standards but a breach of medical and legal obligations. Then, aims of this study were: (1) to describe the reasons for a lawsuit in France following total primary hip (THA) and total knee (TKA) arthroplasties and (2) to compare litigation characteristics of private and public practices. MATERIALS AND METHODS Civil (private practice) and administrative (public practice) court decisions in France between 1990 and 2020 were collected using the two main legal data sources (Legifrance, Doctrine). RESULTS Eighty-three TKA and 173 THA cases were identified. Reasons for complaint in primary THA were mainly infection (29%), prosthetic failures (18%), nerves injuries (17%), and leg length discrepancies (11%). The main grounds for complaint in favor of the plaintiff were diagnostic or indication mistakes (100%), infections (80%), especially if a lack of information was recognized (88%). Reasons for complaint following primary TKA were mainly infections (65%) and persistent pain or stiffness (12%). Whatever the reason, the verdict was in favor of the plaintiff in about 2/3 of the cases. THAs were more at risk of appeal in administrative procedures than in civil (p = 0.008). There were more cases of implant failure in civil proceedings (p = 0.008). Indemnities after primary THA was higher in public activity litigation (p = 0.04). There were no differences in verdicts, grounds for complaints, and compensation between public and private practices for primary TKA. CONCLUSION The main complaint about all the arthroplasties in France was a septic complication. The lack of information could be an added pejorative element for the final verdict.
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Liu S, Zou J, Wang S, Liu G, Zhang Y, Geng S. Litigation analysis of medical damage after total knee arthroplasty: a case study based on Chinese legal database in the past ten years. ARTHROPLASTY 2022; 4:37. [PMID: 36180903 PMCID: PMC9526297 DOI: 10.1186/s42836-022-00141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The medical damage litigations after knee arthroplasty are on the rise year by year. However, few studies examined the litigation after knee arthroplasty. This study analyzed the litigation of medical damage after knee replacement in the past ten years based on a Chinese database. It synthesized the focus of the dispute in these cases to provide a reference for doctors to reduce the risk of litigation. METHODS Retrospectively analyzed were medical damage litigations after total knee arthroplasty in the past ten years (June 2011-June 2021) from the "Wolters Kluwer Legal Information Database". The data collected included the characteristics of patients, causes of litigation, the results of litigation and the amount of compensation. RESULTS A total of 110 litigation cases were analyzed, including 40 male patients (36.3%) and 70 female patients (63.6%). The top cause of litigation was infection (43.6%). The most common factor leading to the doctor losing the case was "complications caused by operational error" (P < 0.05). Complications, such as amputation, postoperative ischemic stroke and infection, were more likely to result in higher compensation. CONCLUSIONS The prevention of infection and the avoidance of operational errors are very important in avoiding medical litigations. Moreover, avoiding disabling complications or a protracted course of disease could significantly reduce the amount of compensation. In addition, full and reasonable communication, paying full attention to the reaction of patients, and timely diagnosis could also effectively minimize the risk of litigation and loss.
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Affiliation(s)
- Shuai Liu
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jilong Zou
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Shuai Wang
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Guangyu Liu
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yan Zhang
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Shuo Geng
- Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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Kamath AF, Durbhakula SM, Pickering T, Cafferky NL, Murray TG, Wind MA, Méthot S. Improved accuracy and fewer outliers with a novel CT-free robotic THA system in matched-pair analysis with manual THA. J Robot Surg 2022. [PMID: 34709535 DOI: 10.1007/s11701-021-01315-3/figures/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Accurate component orientation and restoration of hip biomechanics remains a continuing challenge in total hip arthroplasty (THA). The goal of this study was to analyze the accuracy/reproducibility of a novel CT-free and pin-less robotic-assisted THA (RA-THA) platform compared to manual THA (mTHA). This matched-pair cadaveric study compared this RA-THA system to mTHA (n = 33/arm), both using the assistance of fluoroscopic imaging, in a group of 14 high-volume arthroplasty surgeons. In both groups, surgeons were asked to aim for 40°/15° for cup inclination/version, and 0 mm of leg length discrepancy (LLD). A validated and accurate method using radio-opaque markers measured cup inclination/version and LLD. The accuracy and reproducibility (fewer outliers) of cup inclination was significantly improved in the robotic group (1.8° ± 1.3° vs 6.4° ± 4.9°, respectively, robotic vs manual; p < 0.001), with no significant difference between groups for version. The reproducibility of LLD was significantly improved in the robotic group (p = 0.003). For all parameters studied, the robotic group had an improved accuracy and lower variance (fewer outliers). The percentage of cases within the more restrictive Callanan safe zone was 100% for RA-THA vs 73% for mTHA (p = 0.002). The CT-free RA-THA platform, using only fluoroscopic imaging, demonstrated more accurate acetabular cup positioning, when compared to the mTHA procedures performed by high-volume hip surgeons (naive to this RA-THA platform), with respect to cup inclination and placement within the Lewinnek/Callanan safe zones. Future study must incorporate economic factors, lower volume surgeons, clinical and patient-centric outcomes, and other radiographic parameters in controlled studies in large sample sizes.
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Affiliation(s)
- Atul F Kamath
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA.
| | | | - Trevor Pickering
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS, 39202, USA
| | | | - Trevor G Murray
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA
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Fano AN, Fields MW, Levidy MF, Ippolito J, Luis J, Dobitsch A, Beebe K. Malpractice litigation following orthopaedic surgery of the hip: Frequency, reasons for lawsuit, and outcomes. Med Leg J 2022; 90:70-75. [PMID: 35249419 DOI: 10.1177/09685332211054694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical malpractice litigation in the United States has resulted in the widespread adoption of defensive medicine practices. Orthopaedic surgery is among the specialties most likely to face a malpractice lawsuit, and hip-related surgeries are commonly involved. This study aimed to analyse malpractice litigation as it relates to hip surgery in the United States. The purpose of this study was to seek answers to the following questions: Has there been an increase or a decrease in the number of hip surgery malpractice cases in recent years? What are the most common reasons for a patient to pursue litigation? Which surgical complications are most likely to result in a lawsuit? What trends do we see in terms of outcomes? The Westlaw legal database was queried for all relevant cases from 2008 to 2018. A retrospective review of cases was conducted and descriptive analyses were performed in order to identify factors associated with hip surgery malpractice litigation. A total of 82 cases were analysed. There was a downtrend in the number of cases per year. Total hip arthroplasty (47 cases, 57.3%) was the procedure most often involved. Procedural error was noted as a reason for litigation in 71 (86.6%) cases. Neurological injury (22 cases, 26.8%), malpositioned hardware (15 cases, 18.3%) and leg length discrepancy (8 cases, 9.8%) were the most common complications listed. The majority of cases resulted in a verdict in favour of the defendant orthopaedic surgeon (48 cases, 58.5%). The mean payout for a plaintiff verdict (20 cases, 24.4%) was $1,647,981 (range, $1,852-$7,000,000) and the mean payout for a settlement (13 cases, 15.9%) was $657,823 (range, $49,000-$3,000,000) (p = 0.063). The study concluded that, within the 10-year period, there was a significant downtrend in hip surgery malpractice cases filed per year. Orthopaedic surgeons were found liable in the minority of cases. As expected, verdicts in favour of plaintiffs resulted in seemingly higher payouts than settlements.
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Affiliation(s)
- Adam N Fano
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | | | | | - Justin Luis
- Rutgers New Jersey Medical School, Newark, NJ, USA
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Improved accuracy and fewer outliers with a novel CT-free robotic THA system in matched-pair analysis with manual THA. J Robot Surg 2021; 16:905-913. [PMID: 34709535 PMCID: PMC9314281 DOI: 10.1007/s11701-021-01315-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
Accurate component orientation and restoration of hip biomechanics remains a continuing challenge in total hip arthroplasty (THA). The goal of this study was to analyze the accuracy/reproducibility of a novel CT-free and pin-less robotic-assisted THA (RA-THA) platform compared to manual THA (mTHA). This matched-pair cadaveric study compared this RA-THA system to mTHA (n = 33/arm), both using the assistance of fluoroscopic imaging, in a group of 14 high-volume arthroplasty surgeons. In both groups, surgeons were asked to aim for 40°/15° for cup inclination/version, and 0 mm of leg length discrepancy (LLD). A validated and accurate method using radio-opaque markers measured cup inclination/version and LLD. The accuracy and reproducibility (fewer outliers) of cup inclination was significantly improved in the robotic group (1.8° ± 1.3° vs 6.4° ± 4.9°, respectively, robotic vs manual; p < 0.001), with no significant difference between groups for version. The reproducibility of LLD was significantly improved in the robotic group (p = 0.003). For all parameters studied, the robotic group had an improved accuracy and lower variance (fewer outliers). The percentage of cases within the more restrictive Callanan safe zone was 100% for RA-THA vs 73% for mTHA (p = 0.002). The CT-free RA-THA platform, using only fluoroscopic imaging, demonstrated more accurate acetabular cup positioning, when compared to the mTHA procedures performed by high-volume hip surgeons (naive to this RA-THA platform), with respect to cup inclination and placement within the Lewinnek/Callanan safe zones. Future study must incorporate economic factors, lower volume surgeons, clinical and patient-centric outcomes, and other radiographic parameters in controlled studies in large sample sizes.
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Aae TF, Jakobsen RB, Bukholm IRK, Fenstad AM, Furnes O, Randsborg PH. Compensation claims after hip arthroplasty surgery in Norway 2008-2018. Acta Orthop 2021; 92:311-315. [PMID: 33459568 PMCID: PMC8231378 DOI: 10.1080/17453674.2021.1872901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Orthopedic surgery is one of the specialties with most compensation claims, therefore we assessed the most common reasons for complaints following total hip arthroplasty (THA) reported to the Norwegian System of Patient Injury Compensation (NPE) and viewed these complaints in light of the data from the Norwegian Arthroplasty Register (NAR).Patients and methods - We collected data from NPE and NAR for the study period (2008-2018), including age, sex, and type of complaint, and reason for accepted claims from NPE, and the number of arthroplasty surgeries from NAR. The institutions were grouped by quartiles into quarters according to annual procedure volume, and the effect of hospital procedure volume on the risk for accepted claim was estimated.Results - 70,327 THAs were reported to NAR. NPE handled 1,350 claims, corresponding to 1.9% of all reported THAs. 595 (44%) claims were accepted, representing 0.8% of all THAs. Hospital-acquired infection was the most common reason for accepted claims (34%), followed by wrong implant position in 11% of patients. Low annual volume institutions (less than 93 THAs per year) had a statistically significant 1.6 times higher proportion of accepted claims compared with higher volume institutions.Interpretation - The 0.8% risk of accepted claims following THAs is 1.6 times higher for patients treated in low-volume institutions, which should consider increasing the volume of THAs or referring these patients to higher volume institutions.
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog
- Department of Health Management and Health Economics, Institute of Health and Society, The Medical Faculty, University of Oslo
| | | | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog
- Sports Medicine Institute, Hospital for Special Surgery, New York, USA
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Characteristics of the medical malpractice cases against orthopedists in China between 2016 and 2017. PLoS One 2021; 16:e0248052. [PMID: 33979345 PMCID: PMC8115811 DOI: 10.1371/journal.pone.0248052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to identify the most frequent reasons for orthopedic medical malpractice, gain insight into the related patient demographics and clinical characteristics, and identify the independent factors associated with it. Methods We collected and analyzed the demographic and injury characteristics, hospital levels and treatments, medical errors, and orthopedist’s degree of responsibility for the patients who were subject to orthopedic medical malpractice at our institution. Univariate and multivariate analyses were performed to identify the factors associated with the orthopedist’s degree of responsibility in the medical malpractice cases. Results We included 1922 cases of medical malpractice in the final analysis. There were 1195 and 727 men and women, respectively (62.2% and 37.8%, respectively). Of the total patients, 1810, 1038, 1558, 1441, and 414 patients (94.2%, 54.0%, 81.1%, 75.0%, and 21.5%, respectively) were inpatients, had closed injuries, underwent surgery, were trauma cases, and had preoperative comorbidities, respectively. Most medical malpractice cases were in patients with fractures and spinal degenerative disease (1229 and 253 cases; 63.9% and 13.2%, respectively), and occurred in city-level hospitals (1006 cases, 52.3%), which were located in the eastern part of china (1001, 52.1%), including Jiangsu and Zhejiang (279 and 233 cases, 14.52% and 52.1%, respectively). Between 2016 and 2017, the orthopedist’s degree of responsibility in medical malpractice claims were deemed as full, primary, equal, secondary, and minor in 135, 654, 77, 716, and 340 orthopedists (7.0%, 34.0%, 4.0%, 37.3%, and 17.7%). Most medical errors made by orthopedists in cases of medical malpractice were related to failure to supervise or monitor cases, improper performance of procedures, and failure to instruct or communicate with the patient (736, 716, and 423 cases; 38.3%, 37.3%, and 22.0%, respectively). The multivariate analysis found that patients with preoperative comorbidities, who sustained humerus injuries, who were aged ≥65 years, who were treated by doctors who failed to supervise or monitor them, and who were treated at the provincial and city level hospitals were more likely to claim that the orthopedist bore a serious degree of responsibility in the medical malpractice case. Conclusions Our results provide detailed information on the plaintiff demographics, clinical characteristics, and factors associated with medical malpractice. Medical malpractice is related to poor treatment outcomes. The first preventative measure that is required is a comprehensive improvement in the medical staff quality, mainly through medical ethics cultivation, and professional ability and technique training. Additionally, failure to supervise or monitor cases was the leading cause of medical malpractice and one of the factors that led to orthopedists bearing an equal and higher responsibility for medical malpractice. Orthopedists should improve patient supervision, especially when treating older patients and those with preoperative comorbidities and humerus injuries.
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Medico-Legal Issues Related to Hip and Knee Arthroplasty: A Literature Review Including the Indian Scenario. Indian J Orthop 2021; 55:1286-1294. [PMID: 33814596 PMCID: PMC8009269 DOI: 10.1007/s43465-021-00398-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.
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Griggs B, Childs T, Birkinshaw J, Badrinath P. Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis. Int J Qual Health Care 2021; 33:5986351. [PMID: 33201992 DOI: 10.1093/intqhc/mzaa141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. DESIGN Cross-sectional analysis using routine data. SETTING NHS trusts in England. PARTICIPANTS A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016-17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. INTERVENTION(S) None. MAIN OUTCOME MEASURES Rate of clinical litigation by trust per 100 000 occupied bed days. RESULTS The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P < 0.001); located in the North of England compared to London (5.22 higher; P < 0.001). Conversely, a higher number of occupied bed days (-0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. CONCLUSIONS This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.
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Affiliation(s)
- Beverley Griggs
- Specialty Registrar in Public Health, Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Tristan Childs
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Jamie Birkinshaw
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Padmanabhan Badrinath
- Consultant in Public Health Medicine, Suffolk County Council & Clinical Lecturer, University of Cambridge
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Khan N, Petersen MM, Mikkelsen KL, Schrøder HM. No-Fault Compensation From the Patient Compensation Association in Denmark After Primary Total Hip Replacement in Danish Hospitals 2005-2017. J Arthroplasty 2020; 35:1784-1791. [PMID: 32220482 DOI: 10.1016/j.arth.2020.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is an annually rising number of performed total hip arthroplasty (THA) surgeries in Denmark and this is expected to become even more common. However, there are still risks of adverse events, which become the basis for compensation claims. In Denmark, there are no studies available concerning filed claims after THA. The aims of this study are to determine the incidence of claims related to THAs in Denmark, the reasons to claim, which claims lead to compensation, the amount of compensation, and trends over time. METHODS In this observational study, we analyzed all closed claims between 2005 and 2017 from the Danish Patient Compensation Association (DPCA). With the intention to contribute to prevention, we have identified the number and outcome of claims. RESULTS There were 2924 cases (ie, 2.5% of all THAs performed in this period). The approval rate was 54%. The number of claims filed was stagnant over time, except for a spike of metal-on-metal (MoM) prosthesis cases. The total payout was USD 29,591,045, and 87% of this was due to nerve damage (USD 9,106,118), infection (USD 6,046,948), MoM prosthesis (USD 4,624,353), insufficient or incorrect treatment (USD 472,500), and fracture (USD 2,088,110). CONCLUSION In total, 2.5% of all THAs performed between 2005 and 2017 lead to a claim submission at the DPCA. One of 2 claims were approved. The majority of payouts were due to nerve damage, infection, MoM prosthesis, insufficient or incorrect treatment, and fracture. Although DPCA manages claims for patients, the data can also provide beneficial feedback to arthroplasty surgeons with the aim of improving patient care.
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Affiliation(s)
- Nissa Khan
- Department of Orthopedic Surgery, Holbæk Hospital, Holbæk, Denmark
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Cichos KH, Ewing MA, Sheppard ED, Fuchs C, McGwin G, McMurtrie JT, Watson SL, Xu S, Fryberger C, Baker DK, Crabtree RM, Murphy AB, Vaughan LO, Perez JL, Sherrod BA, Edmonds BW, Ponce BA. Trends and Risk Factors in Orthopedic Lawsuits: Analysis of a National Legal Database. Orthopedics 2019; 42:e260-e267. [PMID: 30763449 DOI: 10.3928/01477447-20190211-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019; 104:43-48. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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Public Perceptions About Nerve Injury From Hip Replacement Surgery. J Arthroplasty 2018; 33:1200-1204.e1. [PMID: 29246714 DOI: 10.1016/j.arth.2017.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nerve injury is a distressing complication for patients and surgeons that is difficult and frustrating to understand and treat. Whether the standard of care has been met when this complication occurs is a common question for both patients and surgeons but there is no information about how the public feels about nerve injury. METHODS The author surveyed 1409 individuals insured in a senior products health program using a 22-item questionnaire about nerve injury during hip replacement. Participants were given written descriptions of total hip arthroplasty, nerve injury, and the standard of care. RESULTS Seventeen percent of participants indicated that a direct nerve laceration is a standard of care violation. Respectively, 98%, 100%, 94%, and 97% of participants responded that the standard of care requires the surgeon to promptly identify the nerve injury, completely inform the patient about the nature and prognosis of the injury, and present options for treating the nerve injury. Eleven percent indicated that they lack trust in health care. Participants with distrust were more likely to find a standard of care violation than other participants. Women and non-white participants responded more commonly that a standard of care violation occurred with the nerve injury. Income level, age, prior surgery, and educational background were not differentiating factors as to whether participants found that a violation of the standard of care had occurred. CONCLUSION Most participants would accept the possibility of nerve injury during hip replacement but they would expect to be informed in advance that this complication is possible.
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Mouton J, Gauthé R, Ould-Slimane M, Bertiaux S, Putman S, Dujardin F. Litigation in orthopedic surgery: What can we do to prevent it? Systematic analysis of 126 legal actions involving four university hospitals in France. Orthop Traumatol Surg Res 2018; 104:5-9. [PMID: 29241815 DOI: 10.1016/j.otsr.2017.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Orthopedic surgery produces 20% of medical malpractice claims. However only a few studies have examined the reasons for and consequences of these disputes, and they have usually been limited to a single hospital. This led us to perform a retrospective analysis of the claims at four teaching hospitals in northwestern France. The goals were (1) to describe the circumstances that led to these claims and recommend ways to prevent them, and (2) to describe the conduct of the proceedings and their financial and social outcomes. HYPOTHESIS A systematic analysis of litigation cases will provide accurate information on the circumstances leading to these claims. METHODS The study included 126 disputes settled between 2000 and 2010 and related to orthopedic or trauma care given at one of four teaching hospitals in northwestern France. The method of recourse, grounds of the complaint, type of surgical procedure, expert findings and amount of the award were systematically analyzed. RESULTS Of these 126 cases, 54 (43%) of them were submitted to the French CRCI (regional conciliation and compensation commission), 48 (39%) to the French administrative courts and 51 (41%) were settled amicably. Multiple methods of recourse were used in 21% of cases (n=27/126). The average length of administrative court proceedings was 36.7±27 months [4-102], which was significantly longer than the CRCI proceedings (22.7±17.9 months [3-80]) or out-of-court settlement (23.7±21.5 months [0-52]) (p<0.0001). Damages were sought for medical error or treatment-related risk in 67.5% of the complaints (n=85/126), and for failure to inform in 15.8% of cases (n=20/126). There was a suspected surgical site infection in 79.3% of cases (n=100/126). There were multiple grounds for complaint in 68.3% of cases (n=86/126). Poor communication between the physician and patient was identified in 26.2% of cases (n=33/126). Damages were awarded in 25% of cases (n=31/126), with an average award of €58,303±€91,601 [0-357,970]. CONCLUSION The primary grounds for legal action are infection-related complications combined with a deterioration in the doctor-patient relationship. Disputes could be prevented by continuing efforts to combat hospital-acquired infections and providing better communications training. LEVEL OF PROOF IV (retrospective study).
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Affiliation(s)
- J Mouton
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - R Gauthé
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - M Ould-Slimane
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - S Bertiaux
- Service de chirurgie orthopédique et traumatologique, hôpital privé de l'estuaire, 505, rue Joliot-Curie, 76620 Le Havre, France
| | - S Putman
- Université de Lille-Nord-de-France, Lille, France; Service de chirurgie orthopédique, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France
| | - F Dujardin
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
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Billon L, Décaudin B, Pasquier G, Lons A, Deken-Delannoy V, Germe AF, Odou P, Migaud H. Prospective assessment of patients' knowledge and informational needs and of surgeon-to-patient information transfer before and after knee or hip arthroplasty. Orthop Traumatol Surg Res 2017; 103:1161-1167. [PMID: 28964919 DOI: 10.1016/j.otsr.2017.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/27/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients are playing an increasingly large role in their own management and must therefore receive clear, complete, and comprehensible information. In the field of hip and knee arthroplasty, little is known about the level of patient knowledge and effectiveness of surgeon-to-patient information transfer. We therefore designed a prospective observational study with the objective of assessing four factors: patient knowledge during management, quality of information transfer, informational needs, and factors associated with the level of knowledge. HYPOTHESIS The level of patient knowledge changes during the management process. PATIENTS AND METHODS A prospective single-centre study was conducted between January 2014 and March 2015 during the outpatient visits and inpatient stays of 63 patients who underwent arthroplasty of the hip (n=36) or knee (n=27). A single observer attended all patient visits and recorded the information provided by the surgeon. Each patient completed a self-questionnaire after the outpatient visit (T1), at admission (T2), and at discharge after surgery (T3). Semi-quantitative scores were used to assess knowledge and informational needs. The effectiveness of information transfer was evaluated by comparing the information provided by the surgeon to the replies made by the patients. RESULTS The mean overall knowledge score (on a 0-42 scale) increased from 17.22±6.33 at T1 to 19.44±6.89 at T3 (P=0.0028). In contrast, knowledge about complications was better at T1 than at T3 (2.67±1.98 vs. 2.19±1.91; P<0.05). Agreement between information given by the surgeon and replies made by patients varied across items from 23% to 100%. The mean informational needs score (on a scale from 0 to 21) ranged from 3.67 to 4.83 and was higher at T3 than at T2 (4.83±3.77 vs. 3.67±4.86; P=0.03). The proportion of patients who wanted written information was higher at T3. Most patients sought information before the outpatient visit. At each step of the management process, the main areas about which the patients wanted information were the surgical procedure, the rehabilitation programme, and the prosthesis. Several socio-demographic or management-related factors influenced the level of knowledge. Thus, older age and lower educational attainment were associated with lower knowledge scores, whereas previous lower-limb orthopaedic surgery and amount of information provided by the surgeon were associated with higher knowledge scores. Knowledge scores were not associated with being employed vs. retired, gender, replacement of a hip vs. a knee, the surgeon, or being accompanied by another person. DISCUSSION Our study is original in that we assessed changes in patient knowledge during the management process for hip or knee arthroplasty. The level of patient knowledge was fairly low and varied considerably across individuals and time points in the management process. These data highlight the importance of providing patients with information throughout their management and particularly at discharge, when the desire for information seems greatest. LEVEL OF EVIDENCE IV, prospective observational study with no control group.
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Affiliation(s)
- L Billon
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59037 Lille, France.
| | - B Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59037 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, université de Lille, CHRU de Lille, 3, rue du Professeur-Laguesse, 59000 Lille, France
| | - G Pasquier
- Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille (CHRU de Lille), rue Emile-Laine, 59037 Lille, France; Université de Lille Nord de France, 59000 Lille, France
| | - A Lons
- Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille (CHRU de Lille), rue Emile-Laine, 59037 Lille, France
| | - V Deken-Delannoy
- EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, CHRU de Lille, 154, rue du Dr-Yersin, 59037 Lille cedex, France
| | - A-F Germe
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59037 Lille, France
| | - P Odou
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59037 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, université de Lille, CHRU de Lille, 3, rue du Professeur-Laguesse, 59000 Lille, France
| | - H Migaud
- Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille (CHRU de Lille), rue Emile-Laine, 59037 Lille, France; Université de Lille Nord de France, 59000 Lille, France
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Lawsuits After Primary and Revision Total Knee Arthroplasty: A Malpractice Claims Analysis. J Am Acad Orthop Surg 2017; 25:e235-e242. [PMID: 28953089 DOI: 10.5435/jaaos-d-16-00736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION As the number of total knee arthroplasties (TKAs) increases, the number of associated complications will also increase. Our goal with this study was to identify common causes of and financial trends relating to malpractice claims filed after TKA. METHODS We analyzed malpractice claims filed for alleged neglectful primary and revision TKA surgeries performed between 1982 and 2012 by orthopaedic surgeons insured by a large New York state malpractice carrier. RESULTS We identified 69 primary and 8 revision TKAs in the malpractice carrier's database. All cases were performed between 1982 and 2012; all claims were closed between 1989-2015. The most frequent factor leading to lawsuits for primary TKA was chronic pain or dissatisfaction in 12 cases, followed by nerve palsy in 8, postoperative in-hospital falls in 5, and deep vein thrombosis or pulmonary embolism in 3. Medical complications included acute respiratory distress syndrome, cardiac arrest, and decubitus ulcers. Contracture was most common after revision TKA (three of eight cases). Mean indemnity was $325,369, and the largest single settlement was $2.42 million. The average expense relating to the defense of these cases was $66,365. CONCLUSIONS Orthopaedic surgeons should continue to focus attention on prevention of complications and on preoperative patient education. Preoperative counseling regarding the risks of incomplete pain relief could reduce substantially the number of suits relating to primary TKAs.
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Patterson DC, Grelsamer RP, Bronson MJ, Moucha CS. Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis. J Arthroplasty 2017; 32:2958-2962. [PMID: 28552444 DOI: 10.1016/j.arth.2017.04.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. METHODS Analysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. RESULTS The incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury ("foot drop") was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. CONCLUSION Nerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education.
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Affiliation(s)
- Diana C Patterson
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York
| | - Ronald P Grelsamer
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York
| | - Michael J Bronson
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York
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Zengerink I, Reijman M, Mathijssen NMC, Eikens-Jansen MP, Bos PK. Hip Arthroplasty Malpractice Claims in the Netherlands: Closed Claim Study 2000-2012. J Arthroplasty 2016; 31:1890-1893.e4. [PMID: 27062353 DOI: 10.1016/j.arth.2016.02.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A total hip arthroplasty (THA) is a successful and reliable operation with few complications. These complications however, do form a potential source for compensation claims. In the Netherlands, there are no studies available concerning filed claims after THA. The aim of this study was to determine the incidence of claims related to THAs in the Netherlands and the reasons to claim, which claims lead to compensation, the costs involved for the insurer, and the demographics of the claimants. METHODS In this observational study, we analyzed all closed claims from 2000 to 2012 from the national largest insurer of medical liability and compared it to data from our national implant registry in the Netherlands. With the intention to contribute to prevention, we have identified the demographics of the claimant, the reasons for filing claims, and the outcome of claims. RESULTS Overall, 516 claims were expressed in 280 closed claim files after THA. Claims were most often related to sciatic nerve injury (19.6%). Most claimants were women (71.6%) with an average age of 63.1 years. The median cost per compensated claim is €5.921. CONCLUSION The claimant is more likely to be female and to be younger than the average patient receiving a THA. The incidence of a claim after a THA is 0.14%-0.30%. Nerve damage is the most common reason to file for compensation. The distribution in reasons to claim does not resemble the complication rate in literature after a THA. The outcome of this study can be used to improve patient care, safety, and costs.
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Affiliation(s)
- Imme Zengerink
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | | | - P Koen Bos
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Chen A, Patel NK, Khan Y, Cobb JP, Gupte CM. The cost of adverse events from knee surgery in the United Kingdom: an in-depth review of the National Health Service Litigation Authority database. Knee 2015; 22:286-91. [PMID: 26006772 DOI: 10.1016/j.knee.2015.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been a significant rise in the number and value of claims against the National Health Service (NHS), with limited studies on litigation in orthopaedic surgery and none in knee surgery alone. We aimed to examine claims against the NHS involving all aspects of knee surgery with respect to costs and trends. CLINICAL RELEVANCE To raise awareness of the reasons for litigation in knee surgery, thus potentially improve patient care and reduce future claims. METHODS We analysed the NHS litigation authority (NHSLA) database for all orthopaedic surgery claims reported to the NHSLA between 2005 and 2010, with calculation of litigation success rates and odds ratios for those relating to knee surgery. RESULTS There were 515 cases identified from the 4609 orthopaedic cases in the NHSLA database (11.2%): 298 (58%) involving total knee replacements (TKRs), 11 (2%) involving unicondylar knee replacements, and 90 cases (30%) remaining open. The total pay out for closed cases was £10.45 million and amputation following TKR resulted in the highest single pay out. Litigation success rates for claimants were highest for retained drains (100%), incorrect prosthesis/prosthesis size (78%), renal failure (75%), poor outcome requiring further surgery (74%) and malalignment (71%). There were also 60 cases of delayed diagnosis which resulted in pay outs totalling £2.90 million. Based on these data, projected future pay out costs for the open TKR cases were estimated to be £2.71 million. CONCLUSION Litigation success rates for TKR were highest following technical errors such as malalignment compared to events less under the surgeon's control, such as infection. The number of claims involving incorrect prosthesis/size continues to be of concern. Despite the increased availability of imaging modalities, missed diagnosis also resulted in substantial pay outs.
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Affiliation(s)
- A Chen
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - N K Patel
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
| | - Y Khan
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - J P Cobb
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - C M Gupte
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
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24
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Whitehouse MR, Stefanovich-Lawbuary NS, Brunton LR, Blom AW. The impact of leg length discrepancy on patient satisfaction and functional outcome following total hip arthroplasty. J Arthroplasty 2013; 28:1408-14. [PMID: 23507069 DOI: 10.1016/j.arth.2012.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/04/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023] Open
Abstract
A series of 191 patients undergoing THA with a standardised stem were studied. The effect of leg length discrepancy (LLD) on patient function (Oxford Hip Score), health measures (Short Form 12) and satisfaction (Self-Administered Patient Satisfaction Scale) at a mean 3.8 years of follow up (range 3.3 to 4.9) is reported. 8.9% of cases had shortening, 0.5% no LLD and 90.6% had lengthening. In 21.5% the LLD was more than 10mm, in 37.1% 5-10mm, and in 40.9% 0-5mm. There was no significant difference in patient reported outcome measures (PROMs) according to LLD. Correlation of recorded measurements between multiple observers was excellent (0.93). LLD following total hip arthroplasty remains common but in this series, was not correlated with PROMs.
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Affiliation(s)
- Michael R Whitehouse
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Lower Level AOC, Southmead Hospital, Westbury-on-Trym, UK
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25
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Whittingham-Jones P, Williams D, Raja S, Bridle S, Bircher M. Negligence claims in UK total hip arthroplasty: a series of 167 consecutive cases. Med Leg J 2012; 80:157-161. [PMID: 23341296 DOI: 10.1258/mlj.2012.012027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A review of negligence reports, detailing 227 complaints from the practices of two orthopedic surgeons, was undertaken. There were demonstrable differences in the number of complaints over leg-length discrepancy; femoral fracture and cup malposition when cemented versus uncemented implants were compared. Surgeons must appreciate the less forgiving nature of uncemented hip implants and the importance of preoperative planning particularly in the presence of abnormal anatomy.
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