Patterson Diana C, Grelsamer Ronald, Bronson Michael J, Moucha Calin S
From the Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY.
J Am Acad Orthop Surg. 2017 Oct;25(10):e235-e242. doi: 10.5435/JAAOS-D-16-00736.
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.
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.
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.
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.
随着全膝关节置换术（TKA）数量的增加，相关并发症的数量也会上升。我们开展这项研究的目的是确定TKA术后医疗事故索赔的常见原因及财务趋势。
我们分析了由纽约州一家大型医疗事故保险公司承保的骨科医生在1982年至2012年间实施的因涉嫌疏忽的初次和翻修TKA手术而引发的医疗事故索赔。
我们在医疗事故保险公司的数据库中确定了69例初次TKA和8例翻修TKA。所有病例均在1982年至2012年间实施；所有索赔均在1989 - 2015年间结案。导致初次TKA诉讼的最常见因素是慢性疼痛或不满意（12例），其次是神经麻痹（8例）、术后住院期间跌倒（5例）以及深静脉血栓形成或肺栓塞（3例）。医疗并发症包括急性呼吸窘迫综合征、心脏骤停和褥疮。挛缩在翻修TKA后最为常见（8例中的3例）。平均赔偿金为325,369美元，最大单笔和解金额为242万美元。这些案件的平均辩护费用为66,365美元。
骨科医生应继续关注并发症的预防以及术前患者教育。关于疼痛缓解不完全风险的术前咨询可大幅减少与初次TKA相关的诉讼数量。
