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Consent process for elective total hip and knee arthroplasty.

Nicolas J Beresford-Cleary1, Nicolas Beresford-Cleary, Jane Halliday

  • 1Department of Orthopaedics, Edinburgh University, The Royal Infirmary of Edinburgh at Little France, Edinburgh, United Kingdom. nick_cleary@hotmail.com

Journal of Orthopaedic Surgery (Hong Kong)
|December 21, 2011
PubMed
Summary

Incomplete documentation of complications for hip and knee replacement surgery consent was found. Structured, procedure-specific consent forms are recommended to improve patient information and safety.

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Area of Science:

  • Orthopaedic Surgery
  • Patient Safety
  • Informed Consent

Background:

  • Informed consent is crucial for elective orthopaedic procedures like total hip replacement (THR) and total knee replacement (TKR).
  • Ensuring comprehensive documentation of potential complications is vital for patient safety and legal compliance.

Purpose of the Study:

  • To evaluate the completeness and accuracy of the consent process for primary total hip replacement (THR) and total knee replacement (TKR) surgeries.
  • To compare documented complications with those listed by the British Orthopaedic Association (BOA) and other relevant sources.

Main Methods:

  • A review of consent forms for 47 THR and 53 TKR patients was conducted.
  • Data collected included documented complications, surgeon's grade, and consent location.

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  • Documented complications were compared against BOA guidelines, literature, and joint registries.

    • Main Results:

    • Significant discrepancies were observed, with complications like 'revision' and 'heterotropic ossification' (THR) and 'revision' and 'dissatisfaction' (TKR) documented but not listed on the BOA form.
    • A substantial percentage of patients had no BOA-listed complications documented (23% THR, 32% TKR) or no complications documented at all (13% THR, 15% TKR).
    • Vague complication descriptions (e.g., morbidity, mortality) were used in 13% of THR and 17% of TKR consent forms.

    Conclusions:

    • The current documentation of complications for hip and knee replacement consent is frequently incomplete and inconsistent.
    • Implementing structured, procedure-specific consent forms is recommended to enhance the quality of informed consent and patient safety.