Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution
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.
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.
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.
KeywordsHip arthroplasty Claim Litigation Complication Costs
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2000) Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 27(7):1745–1752Google Scholar
- 5.Saleh KJ, Kassim R, Yoon P, Vorlicky LN (2002) Complications of total hip arthroplasty. Am J Orthop 31(8):485–488Google Scholar
- 8.Italian Cassation Court On-line Archives. www.italgiure.giustizia.it/sncass. Accessed Sept 2017
- 9.Scott CEH, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC (2012) Patient expectations of arthroplasty of the hip and knee. Bone Joint J 94-B(7):974–981Google Scholar
- 16.Prous J (2009) The changing face of healthcare. Eur Biopharm Rev 35:66–67Google Scholar
- 19.McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A (2014) Preoperative education for hip or knee replacement. Cochrane Database Syst Rev 5:CD003526Google Scholar