Shimizu Michelle R, Bacevich Blake M, Seo Henry H, Rezazadehsaatlou Mohammadamin, Huang Ziwei, Kwon Young-Min
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2025 Mar;40(3):592-596. doi: 10.1016/j.arth.2024.09.020. Epub 2024 Sep 16.
Total joint arthroplasty (TJA) is the most common procedure associated with malpractice claims within orthopaedic surgery. Although prior research has assessed prevalent causes and outcomes of TJA-related lawsuits before 2018, the dynamic healthcare environment demands regular re-evaluations. This study aimed to provide an updated analysis of the predominant causes and outcomes of TJA-related malpractice lawsuits and analyze the outcomes of subsequent appeals following initial jury verdicts.
A legal database was queried for cases between 2018 and 2022 involving primary hip and knee TJA in the United States. Cases were listed as original rulings or appeals and reviewed for the alleged negligence, damages incurred, demographics, and verdicts. Appeals were further assessed for appellant details, preliminary judgment, and outcomes. The findings were compared to previous litigation data using descriptive statistics.
The final cohort comprised 59 cases: 33 (56%) total knee arthroplasty (TKA) and 26 (44%) total hip arthroplasty (THA). The TKA cases primarily cited pain (24%), while the THA cases cited nerve injuries (31%). Negligence largely stemmed from procedural error (47%), postsurgical error (27%), and failure to inform (14%). Case outcomes were in favor of the defense in 66% of cases. Overall, 90% of primary verdicts led to appeals, with 71% by the plaintiff. Initial rulings were upheld in 87% of plaintiff appeals, whereas 53% of defendant appeals retained the initial judgment.
The primary cause of litigation shifted from infection to ongoing/worsening pain in TKA cases over time. While nerve injury TKA cases have decreased, it remains the most cited damage after THA. Defense verdicts are common, but there is an increasing number of verdicts against defendants. Plaintiffs are more likely to appeal, but are less successful in appellate courts. These findings allow surgeons and policymakers to address emerging litigation trends in TJA to mitigate risks and improve the overall quality of TJA.
全关节置换术（TJA）是骨科手术中与医疗事故索赔相关的最常见手术。尽管先前的研究已经评估了2018年之前TJA相关诉讼的常见原因和结果，但动态的医疗环境需要定期重新评估。本研究旨在对TJA相关医疗事故诉讼的主要原因和结果进行更新分析，并分析初审陪审团裁决后的后续上诉结果。
查询一个法律数据库，以获取2018年至2022年期间美国涉及初次髋膝关节TJA的案例。案例被列为原始裁决或上诉，并对指控的过失、造成的损害、人口统计学和裁决进行审查。对上诉进一步评估上诉人细节、初步判决和结果。使用描述性统计将研究结果与先前的诉讼数据进行比较。
最终队列包括59个案例：33个（56%）全膝关节置换术（TKA）和26个（44%）全髋关节置换术（THA）。TKA案例主要 cited疼痛（24%），而THA案例 cited神经损伤（31%）。过失主要源于程序错误（47%）、术后错误（27%）和未告知（14%）。66%的案例结果有利于被告。总体而言，90%的初审裁决导致上诉，其中71%由原告提出。87%的原告上诉维持了初审裁决，而53%的被告上诉维持了初审判决。
随着时间的推移，TKA案例中诉讼的主要原因从感染转移到持续/加重疼痛上。虽然神经损伤的TKA案例有所减少，但它仍然是THA后最常被 cited的损害。被告胜诉的裁决很常见，但针对被告的裁决数量在增加。原告更有可能上诉，但在上诉法院不太成功。这些发现使外科医生和政策制定者能够应对TJA中出现的诉讼趋势，以降低风险并提高TJA的整体质量。
