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Published on: December 3, 2017
Reasons for Litigation in Arthroplasty Infections and Lessons Learned
Olivia Senard1, Thierry Houselstein2, Anne-Claude Crémieux3
1Département de Maladies Infectieuses, Hôpital Raymond Poincaré, AP-HP, Université de Versailles, Versailles, France.
Background:
Infections complicate a minority of orthopaedic arthroplasties but are the leading cause of malpractice claims. The basis for the claims is unclear. The objective of this study was to identify the main deviations from current recommendations by reviewing patient files recorded by a major French medical liability-specialized insurance company for private practitioners (MACSF [Mutuelle d'Assurance du Corps de Santé Français]) and to analyze legal claims and outcomes of litigation.
Methods:
All claims data for periprosthetic joint infections were analyzed retrospectively from 2010 to 2014. Treatment strategies were compared with therapeutic guidelines published by medical societies.
Results:
Forty-five claims for periprosthetic joint infection were recorded; 82% of patients were men and the mean patient age was 63 years. Twenty-one patients (47%) had a knee arthroplasty, 21 had a hip arthroplasty, 2 had a shoulder arthroplasty, and 1 had an ankle arthroplasty. Twenty-three infections (51%) occurred within 1 month postoperatively. Staphylococcus aureus was isolated from intraoperative samples in 36% of the cases (including 25% of these with methicillin-resistant strains), and coagulase-negative staphylococci were isolated in 51% (44% methicillin-resistant strains) of the cases. Treatment lasted for a median of 9.5 months (range, 1.5 to 96 months), with a median of 6 months (range, 1.5 to 20 months) of antibiotics and 3 surgical procedures (range, 0 to 7 surgical procedures). A total of 18% of patients had antibiotic-related side effects, 2% of patients died, and 76% of patients had persistent sequelae. An infectious disease specialist's advice was required for 56% of the patients. Discordances with therapeutic guidelines were found in 76% of the patient files, including delay in diagnosis (44%) and inadequate medical treatment (18%) or medico-surgical treatment (13%).
Conclusions:
Late diagnosis of early postoperative infections appears to be the major cause of inappropriate management and malpractice litigation. Discordance with current guidelines was identified. Early consultation with an infectious disease specialist may help to reduce malpractice claims.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Insights
Delayed diagnosis of periprosthetic joint infections leads to malpractice claims. Adhering to guidelines and consulting infectious disease specialists can mitigate litigation risks in orthopaedic arthroplasty care.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Medical Malpractice Law
Background:
- Periprosthetic joint infections (PJIs) are infrequent but are the primary driver of malpractice claims in orthopaedic arthroplasty.
- The underlying reasons for these claims are not well understood.
- This study investigates deviations from clinical recommendations in PJI cases to understand malpractice litigation basis.
Purpose of the Study:
- To identify key deviations from current PJI management guidelines.
- To analyze malpractice claims and litigation outcomes related to PJIs.
- To determine factors contributing to litigation in arthroplasty infections.
Main Methods:
- Retrospective analysis of 45 PJI malpractice claims from 2010 to 2014.
- Comparison of patient treatment strategies with established medical society guidelines.
- Review of patient files from a French medical liability insurance company (MACSF).
Main Results:
- 76% of cases showed discordance with therapeutic guidelines, notably delayed diagnosis (44%) and inadequate treatment (18-13%).
- Staphylococcus aureus and coagulase-negative staphylococci were common pathogens, with high rates of methicillin-resistance.
- High rates of sequelae (76%) and antibiotic side effects (18%) were observed, with 2% mortality.
Conclusions:
- Late diagnosis of early postoperative PJIs is a significant factor in inappropriate management and malpractice litigation.
- Adherence to current PJI management guidelines is crucial.
- Early consultation with infectious disease specialists may reduce malpractice claims and improve patient outcomes.
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