Hip and knee arthroplasties and their significance in personal injury practice

Abstract

Complications of hip and knee arthroplasty are frequently a source of litigation. The circumstances surrounding the complication - and whether it results from substandard care - need to be opined upon by a surgeon with considerable experience in that field. The subject was reported by McWilliams et al1 from a review of the records of the NHS Litigation Authority (NHSLA) in the UK. However, hip and knee arthroplasty is also a source of interest in some personal injury claims, particularly after tibial plateau and acetabular fractures. Legal advisers are usually interested in four things: *What is the likelihood of arthroplasty in the future? *When is it likely to be required? *What is the likely outcome, i.e. is the outcome similar in nature to arthroplasty for non-traumatic osteoarthritis? What is the likelihood of a revision being required in the patient/claimant’s lifetime? *If the patient/claimant is still in employment, how much time will they lose from work and how likely are they to get back to work? All orthopaedic surgeons are aware that the decision to recommend joint arthroplasty for a painful symptomatic hip/knee joint is very much a quality of life decision. This applies in both the post-traumatic and non-traumatic situation. A proper risk/benefit analysis needs to be conducted with the patient. The likelihood of post-traumatic arthritis developing after hip or knee injury depends upon the precise nature of the original injury and the adequacy of the initial surgery, if the fracture was treated operatively. Following analysis of the case, the expert should be in a position to make an educated estimate as to whether and when arthroplasty will be required in the future on the basis …