1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
Law Medicine Unit, University Hospital of Pisa, Pisa, Italy.
Musculoskelet Surg. 2020 Apr;104(1):43-48. doi: 10.1007/s12306-019-00590-6. Epub 2019 Feb 13.
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.
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.
近年来，全髋关节置换术的数量一直在稳步增加。尽管手术效果有所改善，但医疗事故索赔的数量却更高。这项工作的主要目的是分析髋关节置换术后的诉讼情况，概述引发诉讼的原因和费用。次要目的是提出一种可能的预防策略，以改善护理并减少法律诉讼。
本研究的数据来自于 2005 年 1 月至 2016 年 12 月我们机构的医疗和法律档案以及专业责任保险。
在总共 4770 例 THA 中，收到了 40 份索赔。周围神经损伤是诉讼的首要原因（37%），其次是感染并发症、肢体长度差异、金属中毒、植入物脱位和一例深静脉血栓形成。从过去审判判决的分析来看，神经损伤和感染等并发症几乎总是被认为是医疗失误，索赔的比例很高。
本研究表明，需要采取预防策略来减少全髋关节置换术的医疗事故索赔数量较高的情况。一些并发症，如神经损伤和感染，通常被认为直接归因于医生的失误。通过提供手术过程勤勉执行和术后管理适当的证据，可以减少诉讼：正确编制具体的知情同意书和充分的医患沟通。
