[Handling of retrieved implants in orthopedic surgery : Results of a survey within the framework of the EndoCert initiative]

BACKGROUND

Although investigations of retrieved medical implants can provide valuable information about the cause of the revision, there is a lack of information, which could be avoided by consequent failure analyses. In the framework of the EndoCert certification system it is obligatory to record and report incidents.

OBJECTIVES

The present work examines how the willingness to report has developed in certified arthroplasty centers and which method of handling retrievals is preferred and actually used.

MATERIALS AND METHODS

On the basis of a questionnaire for handling retrievals, all 508 arthroplasty centers that were certified till June 1, 2016, were included (return rate = 97.2%).

RESULTS

A total of 93.3% of the centers have established an algorithm for handling of retrievals and 83.0% of the centers prefer to hand out the retrieval to the patient, while only 25.7% wish to store it in the center for research purposes. In the case of a potential incident as the cause of revision, centers prefer to forward the retrieval to damage analysis, whereby the centers act in different ways, depending on the case. An implant fracture is, e.g., considered a reportable event in most cases without temporal limitation. On the other hand, breakage or failure of surgical instruments is considered not to be reported in the case of more than half of the centers. In 2014 and 2015, approximately 71% of EPZs reported no incidents.

CONCLUSIONS

According to our survey, many certified arthroplasty centers are sensitized to careful handling of retrievals. The treatment of the explanted components is conducted in different ways. The assessment of whether an incident is to be reported shows large differences. In view of the relatively high number of revision surgeries, the number of reports to the authorities appears to be low.

[The interdisciplinary approach in reconstructive surgery of the extremities]

In cases of extended post-traumatic soft-tissue and bone loss as well as with mutilating infection or radical tumor resection, multidisciplinary options are required to salvage extremities and functional rehabilitation. A surgical team approach allows for reduction of amputation rates, wound healing complications, and secondary procedures in limb oncology and trauma. The goals and limitations of cooperative surgical concepts are described. In the future, continuing medical education will focus not only on indications and techniques but also on complication management, medicolegal problems, and economic deficits due to maladapted legal structures. Provided clear clinical pathways are introduced to guide indications, surgical procedures, and postoperative treatment, marked financial deficits may be avoided. While, in the past, responsibility for the patient and ethical considerations resulted in the development of voluntary interdisciplinary treatment programs, economic strategies and an increasing number of malpractice suits will inevitably produce new imperatives for interdisciplinary cooperation in the future.

[Categories for evaluating surgical procedures by expert medical witnesses]

An analytical procedure is presented that helps to determine the causes of surgical malpractice. A first evaluation scale of six levels is applied to the assessment of the indications for surgery and the method used as well as a second scale for the technical realisation of the treatment. For the indication and method categories A-F are used.A: method of choice; B: a time-tested method but second choice; C: exceptional method, rarely practised; D: historical method no longer in use; E: incorrect method/simple mistake; F: blatant mistake in the assessment of indication or choice of method, not understandable. To evaluate the technical realisation of treatment a scale from 1 to 6 is applied. 1: excellent realisation; 2: successful, but minor drawbacks; 3: atypical but acceptable result; 4: technically failed but no harm to the patient; 5: insufficient realisation; 6: faulty, grossly failed. Three cases are given as examples. In these cases the use of the proposed categories and scaling leads to differentiated assessments.

[Medical-legal aspects in fractured ceramic liners after implantation of a hip endoprosthesis]

We report the case of a male patient after implantation of a thrust plate endoprosthesis to discuss reliable questions concerning the insurance and liability fields. The indication for implantation of this type of endoprosthesis should be decided critically. To prevent an early implant failure, both articulating ceramic partners - the liner and the femoral head - should be exchanged in any case of doubt during a hip revision surgery. In case of an implant failure, a surface analysis of the broken fragments can show signs of material insufficiencies. A detailed preoperative consent of the patient combined with an exact documentation is necessary to prevent potential medical claims by the patient, and also increases the compliance and reduces the costs for the health system.