Informed Consent in Elective Orthopedic Surgeries: A Scoping Review of Medico-Legal Challenge and Team-Based...

Despite established ethical principles, a critical synthesis of how informed consent deficiencies, leading to costly malpractice lawsuits in elective orthopedic surgery, relate to medico-legal outcomes, documentation pitfalls, and team roles is lacking. This scoping review aimed to investigate the status of obtaining informed consent by the treatment team in elective orthopedic surgeries and the related legal consequences.

Following the Arksey & O'Malley framework update by Levac et al., we conducted a comprehensive search across PubMed, Scopus, Web of Science databases, and the Google Scholar search engine. Studies focusing on informed consent, legal factors, and the treatment team in elective orthopedic procedures were included in this review. Data were charted and analyzed using thematic analysis for qualitative synthesis, supplemented by quantitative summary statistics.

Qualitative analysis identified four themes: documentation patterns, legal factors, cultural considerations, and risk mitigation strategies. Findings showed frequent documentation gaps (13%-32% of forms lacked specific complications). Nerve injury was the most common cause of lawsuits (46%-56%). In lumbar fusion, 24% of claims cited failure to obtain consent. US compensation averaged $871 093, vastly exceeding European figures. Patient recall of complications was poor (22.5%) but improved to 48% with written aids.

The informed consent process in elective orthopedics faces systematic challenges, including inconsistent documentation, high litigation risk, and inadequate patient understanding. To reduce legal exposure and promote safety, implementing evidence-based, procedure-specific consent forms, interdisciplinary team training, and culturally competent communication is recommended. Addressing these requires coordinated policy reform at institutional and educational levels.