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Postoperative pain and infection are the most frequent reasons for legal action after knee arthroscopy: a 5-year review based on two private insurance French companies after arthroscopy

  • SPORTS TRAUMATOLOGY
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objective of this study was to determine the reasons for complaints and describe the judicial means upstream of France's courts following arthroscopy.

Methods

This is a retrospective observational study including all compensation records related to arthroscopic surgery, collected from the two leading French insurance organizations: MACSF and Branchet companies, from 2014 to 2018. Three medical experts performed the protocol and analysis.

Results

Finally, 247 procedures were included. The most common motives were: the appearance or persistence of pain (43.7%), postoperative infection (29.1%), technical errors (10.5%), nerve damage (5.7%), arterial lesions (2.8%), side errors (2.4%). Knee arthroscopies were more at risk of legal action for infection (p = 0.0006), and for disappointing results or persistent pain (p = 0.001). The first recourse was the conciliation and compensation commission (CCI) in 136 cases (55.1%), the civil court (TGI) in 88 cases (35.6%) and amicable settlement in 23 cases (9.3%). The mean time between surgery and the complaint was 32.8 ± 25.7 months, and was shorter in the case of an amicable procedure (p < 0.001). The lawsuit's mean duration was 15.6 ± 11.2 months, but longer in case of civil proceedings (p < 0.0001). The experts found no negligence in 81.8% of cases (n = 202). Infections were the leading cause of recourse to the conciliation and compensation commission (p < 0.0001), while technical errors were the main reason for complaints settled in an amicable procedure (p = 0.035). It was found more proven negligence in case of amicable procedures (p < 0.0001). The mean amount of compensation was 60,968.45€. No significant difference could be found regarding the median values of compensation between the reason of complaint. The amount of compensation was higher in civil court proceedings than in any others (p = 0.02).

Conclusion

The main reasons for arthroscopy litigation in France are reported in this study, specifying how they are managed upstream of possible legal proceedings. The knee is the main joint involved. Patient information, close follow-up associated with early and appropriate management of complications are the main ways to reduce complaints.

Level of evidence

IV.

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References

  1. Attarian DE, Vail TP (2005) Medicolegal aspects of hip and knee arthroplasty. Clin Orthop Relat Res 433:72–76

    Article  Google Scholar 

  2. Adamson TE, Tschann JM, Gullion DS, Oppenberg AA (1989) Physician communication skills and malpractice claims. A complex relationship. West J Med 150:356–360

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Agout C, Rosset P, Druon J, Brilhault J, Favard L (2018) Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: a 10-year retrospective study. Orthop Traumatol Surg Res 104:11–15

    Article  CAS  Google Scholar 

  4. Benson M, Boehler N, Szendroi M, Zagra L, Puget J (2014) Ethical standards for orthopaedic surgeons. Bone Jt J 96:1130–1132

    Article  Google Scholar 

  5. Bhutta ZA (2004) Beyond informed consent. Bull World Health Organ 82:771–777

    PubMed  PubMed Central  Google Scholar 

  6. Bokshan SL, Ruttiman R, Eltorai AEM, DePasse JM, Daniels AH, Owens BD (2017) Factors associated with physician loss in anterior cruciate ligament reconstruction malpractice lawsuits. Orthop J Sports Med 5(11):2325967117738957

    Article  Google Scholar 

  7. Bokshan SL, Ruttiman RJ, DePasse JM, Eltorai AEM, Rubin LE, Palumbo MA, Daniels AH (2017) Reported litigation associated with primary hip and knee arthroplasty. J Arthroplasty 32:3573-3577.e1

    Article  Google Scholar 

  8. Cancienne JM, Brockmeier SF, Carson EW, Werner BC (2018) Risk factors for infection after shoulder arthroscopy in a large medicare population. Am J Sports Med 46:809–814

    Article  Google Scholar 

  9. Disegni E, Martinot P, Dartus J, Migaud H, Putman S, May O, Girard J, Chazard E (2021) Hip arthroscopy in France: an epidemiological study of postoperative care and outcomes involving 3699 patients. Orthop Traumatol Surg Res 107(1):102767

    Article  Google Scholar 

  10. European Socio economic Groups—Nomenclature socio-économique européenne—F2016/04-Insee http://www.insee.fr/fr/statistiques/2022135. 19 Feb 2016

  11. Erivan R, Tardieu A, Villatte G, Ollivier M, Jacquet C, Descamps S, Boisgard S (2020) Knee surgery trends and projections in France from 2008 to 2070. Orthop Traumatol Surg Res 106(5):893–902

    Article  Google Scholar 

  12. Ferrara SD, Baccino E, Bajanowski T, Boscolo-Berto R, Castellano M, De Angel R, Pauliukevičius A, Ricci P, Vanezis P, Vieira DN, Viel G, Villanueva E, EALM Working Group on Medical Malpractice (2013) Malpractice and medical liability. European Guidelines on Methods of Ascertainment and Criteria of Evaluation. Int J Legal Med 127:545–557

    Article  Google Scholar 

  13. Gibon E, Farman T, Marmor S (2015) Knee arthroplasty and lawsuits: the experience in France. Knee Surg Sports Traumatol Arthrosc 23:3723–3728

    Article  Google Scholar 

  14. Gil JA, Waryasz GR, Owens BD, Daniels AH (2016) Variability of arthroscopy case volume in orthopaedic surgery residency. Arthroscopy 32:892–897

    Article  Google Scholar 

  15. Gould MT, Langworthy MJ, Santore R, Provencher MT (2003) An analysis of orthopaedic liability in the acute care setting. Clin Orthop Relat Res 407:59–66

    Article  Google Scholar 

  16. HAS (Haute Autorité de Santé), Rapport sur la pertinence de l’arthroscopie dans les autres localisations www.has-sante.fr. 04 Jun 2014

  17. Jena AB, Seabury S, Lakdawalla D, Chandra A (2011) Malpractice risk according to physician specialty. N Engl J Med 365:629–636

    Article  CAS  Google Scholar 

  18. Kluge R, Koob R (2001) Expert assessment of medical malpractice. Orthopade 30:117–120

    Article  CAS  Google Scholar 

  19. Loi no. 2002–303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé—Légifrance (legifrance.gouv.fr)

  20. Lubowitz JH, Brand JC, Rossi MJ (2018) Malpractice litigation after arthroscopy. Arthrosc J Arthrosc Relat Surg 34:2009

    Article  Google Scholar 

  21. Marmor S, Farman T, Lortat-Jacob A (2009) Joint infection after knee arthroscopy: medicolegal aspects. Orthop Traumatol Surg Res 95:278–283

    Article  CAS  Google Scholar 

  22. McWilliams AB, Douglas SL, Redmond AC, Grainger AJ, O’Connor PJ, Stewart TD, Stone MH (2013) Litigation after hip and knee replacement in the National Health Service. Bone Jt J 95B:122–126

    Article  Google Scholar 

  23. Mouton J, Gauthé R, Ould-Slimane M, Bertiaux S, Putman S, Dujardin F (2018) 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 104:5–9

    Article  CAS  Google Scholar 

  24. No authors listed. Loi no. 2002–303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. http://www.legifrance.gouv.fr. 01 Jul 2016

  25. Pioger C, Jacquet C, Abitan A, Odri GA, Ollivier M, Sonnery-Cottet B, Boisrenoult P, Pujol N (2020) Litigation in arthroscopic surgery: a 20-year analysis of legal actions in France. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06182-3

    Article  PubMed  Google Scholar 

  26. Salzler MJ, Lin A, Miller CD, Herold S, Irrgang JJ, Harner CD (2014) Complications after arthroscopic knee surgery. Am J Sports Med 42:292–296

    Article  Google Scholar 

  27. Senard O, Houselstein T, Crémieux AC (2019) Reasons for litigation in arthroplasty infections and lessons learned. J Bone Jt Surg Am 101:1806–1811

    Article  Google Scholar 

  28. Shah KN, Eltorai AEM, Perera S, Durand WM, Shantharam G, Owens BD, Daniels AH (2018) Medical malpractice litigation following arthroscopic surgery. Arthroscopy 34:2236–2244

    Article  Google Scholar 

  29. Tarantino U, Giai Via A, Macrì E, Eramo A, Marino V, Marsella LT (2013) Professional liability in orthopaedics and traumatology in Italy. Clin Orthop Relat Res 471:3349–3355

    Article  Google Scholar 

  30. Truog RD (2012) Patients and doctors—evolution of a relationship. N Engl J Med 366(7):581–585

    Article  CAS  Google Scholar 

  31. Tabibian BE, Kuhn EN, Davis MC, Pritchard PR (2017) Patient expectations and preferences in the spinal surgery clinic. World Neurosurg 106:595–601

    Article  Google Scholar 

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Acknowledgements

The authors thank the attorney at law Anne-Elisabeth Leduc (Paris Bar) for her contribution.

Funding

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Grégoire Rougereau, Théo Kavakelis, Frédéric Zadegan & Didier Ollat

  2. Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Grégoire Rougereau

  3. Department of Orthopedics and Traumatology, Cochin Hospital, AP-HP, Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France

    Frédéric Sailhan

  4. Department of Orthopedic Surgery, Clinique Arago, 187 Rue Raymond Losserand, 75014, Paris, France

    Frédéric Sailhan

  5. M.A.C.S.F Mutuelle d’Assurances du Corps de Santé Français, CR Triangle de l’arche, 10 Rue de Valmy, 92800, Puteaux, France

    Nicolas Chanzy

  6. Department of Orthopedics Pediatrics, Children Hospital Purpan, Toulouse University, Toulouse, France

    Tristan Langlais

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  1. Grégoire Rougereau
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Contributions

GR participated in the data interpretation, and article writing. TK participated in the study design and data acquisition. FZ and DO participated in the study design and article review. TL participated in data interpretation and article review. NC and FS participated in the study design, data acquisition and article review. Three authors (NC, FS, DO) reviewed the article with legal expert oversight. Each author has given final approval of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Grégoire Rougereau.

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Conflict of interest

GR, TK, FZ, NC, FS, TL and DO have nothing to disclose.

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No ethical approval was need for this study.

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Rougereau, G., Kavakelis, T., Sailhan, F. et al. Postoperative pain and infection are the most frequent reasons for legal action after knee arthroscopy: a 5-year review based on two private insurance French companies after arthroscopy. Knee Surg Sports Traumatol Arthrosc 29, 3551–3559 (2021). https://doi.org/10.1007/s00167-021-06586-9

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