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. 2022 Nov;142(11):3505-3513.
doi: 10.1007/s00402-021-04228-w. Epub 2021 Oct 25.

Litigation after primary total hip and knee arthroplasties in France: review of legal actions over the past 30 years

Grégoire Rougereau  1   2 , Thibaut Marty-Diloy  3 , Tristan Langlais  4   5 , Nicolas Pujol  6 , Philippe Boisrenoult  6
Affiliations

Litigation after primary total hip and knee arthroplasties in France: review of legal actions over the past 30 years

Grégoire Rougereau et al. Arch Orthop Trauma Surg. 2022 Nov.

Abstract

Introduction: Since the law of March 4, 2002, several modifications have impacted medical practices and their medico-legal implications. In case of an infectious complication not related to a fault of the practitioners (surgeons, anesthetists), the patient has the right to compensation assumed by the care structures. Moreover, the lack of preoperative information is no longer just a failing of the ethical standards but a breach of medical and legal obligations. Then, aims of this study were: (1) to describe the reasons for a lawsuit in France following total primary hip (THA) and total knee (TKA) arthroplasties and (2) to compare litigation characteristics of private and public practices.

Materials and methods: Civil (private practice) and administrative (public practice) court decisions in France between 1990 and 2020 were collected using the two main legal data sources (Legifrance, Doctrine).

Results: Eighty-three TKA and 173 THA cases were identified. Reasons for complaint in primary THA were mainly infection (29%), prosthetic failures (18%), nerves injuries (17%), and leg length discrepancies (11%). The main grounds for complaint in favor of the plaintiff were diagnostic or indication mistakes (100%), infections (80%), especially if a lack of information was recognized (88%). Reasons for complaint following primary TKA were mainly infections (65%) and persistent pain or stiffness (12%). Whatever the reason, the verdict was in favor of the plaintiff in about 2/3 of the cases. THAs were more at risk of appeal in administrative procedures than in civil (p = 0.008). There were more cases of implant failure in civil proceedings (p = 0.008). Indemnities after primary THA was higher in public activity litigation (p = 0.04). There were no differences in verdicts, grounds for complaints, and compensation between public and private practices for primary TKA.

Conclusion: The main complaint about all the arthroplasties in France was a septic complication. The lack of information could be an added pejorative element for the final verdict.

Keywords: France; Indemnity; Litigation; Malpractice; Total hip arthroplasty; Total knee arthroplasty.

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