Medical Malpractice Litigation Following Revision Total Hip and Knee Joint Arthroplasty: A Review of Reported Legal Claims in the United States in the Past 20 Years

Background: The increasing incidence of primary total hip (THA) and knee (TKA) arthroplasty has been accompanied by a subsequent rise in revision surgeries. Revision total joint arthroplasty (TJA) is associated with major litigation risk, primarily due to procedural and postsurgical errors. However, the understanding of the causes and outcomes of revision TJA malpractice cases remains unstudied. This study aimed to analyze litigated malpractice claims against orthopaedic surgeons performing revision TJA using a national legal database.

Methods: A database was queried for a nationwide analysis of medical malpractice litigation in revision TJA from 2000 to 2023. Data on the time, duration, and locations of the litigations, allegations of surgical negligence, the damages cited, the outcomes of the trials, and indemnities were collected.

Results: Of 110 TJA malpractice cases identified over two decades, 32 cases involving revision THA and TKA surgeries were included in the final analysis. The cases were equally divided between THA and TKA, spanning 16 states, with the highest proportions in New York, Connecticut, and Louisiana. "Procedural error" (28%; n = 9) was the most frequently cited negligence, followed by "postsurgical error" (25%; n = 8) and "failure to treat" (19%; n = 6). The most common damages were "continued pain or mobility limitations" (28%; n = 9) and "infections" (19%; n = 6). Most cases resulted in a verdict for the defense (63%; n = 20). The average indemnity was $5,713,635, with considerable variability.

Conclusions: This study presents the leading causes of litigated malpractice claims over the past two decades in the United States in revision TJA as perceived procedural and postsurgical errors, with the most common damages reported being "persistent pain or mobility limitations" and "infections." Given the rising incidence of revision TJA, orthopaedic surgeons may utilize these trends to better inform patients about the potential risks and outcomes of surgery and mitigate litigation risks.