Reasons for malpractice claims after first revision of total hip arthroplasty in France: Insurance data from 263 consecutive claims from 2010 to 2023.

Introduction: With an increasing number of surgical procedures, particularly due to the aging population, we are facing an increase in the number of total hip arthroplasty (THA) revisions and, consequently, conflicts between surgeons and patients. There are very little data specifically dedicated to THA revisions in the international literature. Therefore, we conducted a retrospective study to identify the most common causes of lawsuits following THA revision in France.

Materials and methods: We reviewed 263 consecutive complaint files following a THA first revision between 2010 and 2023 from the Cabinet Branchet (CB) database. Collected data included: nature of the pathology leading to the revision, time between revision and complaint, American Society of Anesthestiologists (ASA) score, age and sex of patients, any complications following the revision, nature of the procedure, attribution of responsibilities, and amount of poured compensation.

Results: These 263 procedures involved 256 patients, 144 men (56.2%) and 112 women (43.7%), with an average age of 61.4 years (27-92) and an average ASA score of 2. The clinical situations leading to THA revision, that eventually resulted in a patient complaint, were: aseptic loosening (70/263, 26.6%), Surgical Site Infection (SSI, 46, 17.5%), dislocation (32, 12.2%), or implant fracture (23, 8.7%). However, in 160 cases (61%), these are the complications following the revision surgery that led to the patient's complaint. These complications were: SSI in 52.5% of cases (93/177), neurological deficit in 12.4% of cases (22/177), death (17 patients, 9.6%), persistent pain (12, 6.7%), and leg length discrepancy (LLD, 11, 6.2%). The 263 final legal proceedings were distributed as follow: 137 in French Commission for Conciliation and Compensation for Medical Accidents (CCI, 52%), 97 in judicial court (36.9%), 26 amicable settlements (9.9%), and 3 others. In 192 cases (73%), the surgeon's legal responsibility was not retained. The average compensation amount was €60,000, and >€100,000 in 6 cases (2.3%).

Discussion: French orthopaedic surgeons are frequently sued. CB data indicates a frequency of one implication every 27 months, excluding the field of spine surgery. Some causes of revision seem to be less well tolerated by patients than others, such as implant fractures or LLD. Nevertheless, our study shows that SSIs are the main cause of litigation, accounting for 52.9% of cases (139/263), either as the primary cause or as secondary cause following complications after first revision surgery.

Conclusion: Aseptic loosening, surgical site infection, recurrent dislocation, and implant fractures are the primary causes of complaints leading to a lawsuit after THA revision in France. These data must be communicated to orthopaedic surgeons to better guide preoperative inform consent discussions with their patients as the quality of preoperative information is often correlated with a favourable outcome following expert advice.

Level of evidence: IV; retrospective study.