Litigation after hip and knee replacement in the National Health Service

Abstract

The results of hip and knee replacement surgery are generally regarded as positive for patients. Nonetheless, they are both major operations and have recognised complications. We present a review of relevant claims made to the National Health Service Litigation Authority. Between 1995 and 2010 there were 1001 claims to a value of £41.5 million following hip replacement surgery and 523 claims to a value of £21 million for knee replacement. The most common complaint after hip surgery was related to residual neurological deficit, whereas after knee replacement it was related to infection. Vascular complications resulted in the highest costs per case in each group.Although there has been a large increase in the number of operations performed, there has not been a corresponding relative increase in litigation. The reasons for litigation have remained largely unchanged over time after hip replacement. In the case of knee replacement, although there has been a reduction in claims for infection, there has been an increase in claims for technical errors. There has also been a rise in claims for non-specified dissatisfaction. This information is of value to surgeons and can be used to minimise the potential mismatch between patient expectation, informed consent and outcome.

Basic biomechanics of the hip

“…[23][24][25][26] A recent review has identified that smaller females are more likely to be susceptible to leg length changes. 20 The reason for this is that a given magnitude of inequality will cause a corresponding change in angle of the pelvis with respect to the sagittal plane. The magnitude of this pelvic angle is inversely proportional to the width of the pelvis, making smaller people more likely to be symptomatic.…”

Leg Length Discrepancy after Total Hip Arthroplasty Using the Modified Anterolateral Approach for Stable Hip

“…The mean preoperative and postoperative leg length discrepancies were -5.8 ± 6.3 and 0.7 ± 3.5 mm, respectively. Three patients had lengthening of the postoperative legs by >5 mm (7,8, and 9 mm), but none had > 10-mm lengthening in comparison to the non-operative side. The results of this research show minimal postoperative leg length discrepancy and global offset, with values of 0.7 ± 3.5 and 0.7 ± 6 mm, respectively.…”

“…One of the major complications after THA is leg length discrepancy, which can sometimes result in litigation [8]. Sykes et al [9] reported that for discrepancies ≥ 5 mm, a significant number of participants were aware of the difference.…”

Economics of Orthopaedic Infections: A Bottomless Pit

“…According to the claims presented to the British NHS Litigation Authority in the period 1995-2010, one of the most common complaints after TKA is for Infection [ 6 ]. The actual direct costs of periprosthetic and other bone and joint infections need thorough evaluation as they are responsible for substantial fi nancial losses in the hospital budgets due to inadequate re-imbursement.…”