Medical Malpractice Litigation Following Hindfoot Arthrodesis

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Category: Hindfoot; Ankle Introduction/Purpose: Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims. Consequently, medical malpractice lawsuits can impose significant economic and psychological burden on orthopedic surgeons. This study aims to investigate malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. Methods: The Westlaw legal database was queried for all cases involving hindfoot arthrodesis using the terms “malpractice” and either “ankle fusion,” “arthrodesis,” “subtalar fusion,” “tibiotalar fusion,” “tibiotalocalcaneal fusion,” “TTC fusion,” or “tibiofibular fusion” from 1987 to present day. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Results: Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (± 456,179). The most commonly alleged category of negligence was procedural/intraoperative error (75%) followed by post-surgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Conclusion: This study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality. Given the frequency of hindfoot arthrodesis performed, it is imperative for orthopedic surgeons to prioritize surgical goals, patient expectations, and complication profiles to reduce the risk of malpractice litigation and improve patient outcomes.