Grégoire Rougereau1,2, Thibaut Marty-Diloy3, Tristan Langlais4,5, Nicolas Pujol6, Philippe Boisrenoult6. 1. Department of Orthopedic and Trauma Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. greg.rougereau@gmail.com. 2. Department of Orthopedic and Trauma Surgery, André Mignot Hospital, University Île-de-France Ouest, 177 Rue de Versailles, 78150, Le Chesnay, France. greg.rougereau@gmail.com. 3. Department of Orthopedic and Trauma Surgery, University Hospital Center, 2 Rue de la Milétrie, 86021, Poitiers, France. 4. Department of Pediatric Orthopedics, Hôpital des enfants, Purpan, Université de Toulouse, Toulouse, France. 5. Department of Pediatric Orthopedics, Hôpital Armand-Trousseau, AP-HP, Sorbonne University, 26 avenue du Dr-Arnold-Netter, 75012, Paris, France. 6. Department of Orthopedic and Trauma Surgery, André Mignot Hospital, University Île-de-France Ouest, 177 Rue de Versailles, 78150, Le Chesnay, France.
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.
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.