HIP ARTHROPLASTY: TRENDS IN LITIGATION IN THE PAST 5 YEARS WITHIN THE UK HEALTHCARE MODEL

Abstract

Background: Over 70,000 hip replacements were performed in England and Wales in 2006/7 during which all litigation claims cost the National Health Service (NHS) over £600 million. Joint arthroplasty surgeons are twice as likely to be subject to litigation claims compared to other physicians. The complications associated with primary hip arthroplasty (HA) are well documented, however those instigating litigation in the UK are not known. In this study, the trends in litigation over the past 5 years were assessed to indentify the instigating factors and their associated success to highlight areas for further improvement in patient information and surgical management.

Methods: Data from the NHS Litigation Authority on claims following HA unrelated to trauma between 2002 and 2007 were obtained and analysed.

Results: 352 claims were made, 271 (77%) were settled of which 109 (40.1%) resulted in a successful claim. The total cost to the NHS was £8,558,000. The number of claims has increased from 54 in 2002 to 83 in 2007, while the rate of successful claims decreased from 46.7% to 12.9%. The three most common instigating factors were nerve injury (19.6%), Operator Error (14.2%) and ongoing pain (13.6%). The factors with greatest successful claims were Non-operative site injuries (70%), Operator Error (66%), Fracture (52.4%).

Conclusion: Litigation claims following Hip Arthroplasty are increasing, although there rate of success is decreasing. Non-operative site injuries, operator error and fractures are predictors of a successful claim. However, failure to consent adequately, adhere to policies and standard practice can result in a successful claim. Protecting patients intra-operatively and maintaining high technical expertise while implementing policies and informed consent decreases the litigation burden to the NHS