Medical Malpractice Litigation Trends Following Primary Total Hip and Knee Joint Arthroplasty: An Updated Nationwide Analysis

Abstract

BackgroundTotal 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. MethodsA 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. ResultsThe final cohort comprised 59 cases: 33 (56%) total knee arthroplasty (TKA) and 26 (44%) total hip arthroplasty (THA) from 2018 to 2022. 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 only 53% of defendant appeals retained the initial judgment. ConclusionThe primary causative factor of litigation shifted from infection to ongoing/worsening pain postoperatively in TKA cases over time. While nerve injury TKA cases have decreased, it remains the most cited damage in THA cases. 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 enhance patient care, mitigate risks, and improve the overall quality of TJA.