Pub Date : 2015-12-01DOI: 10.1302/2048-0105.46.360389
S. Ahmed
The number of clinical negligence claims in the UK is constantly increasing. As a specialty, trauma and orthopaedic surgery has one of the highest numbers of negligence claims. 1 This study analyses NHS Litigation Authority (NHSLA) claims in trauma and orthopaedics between 2004 and 2014. A formal request was made to the NHSLA under the Freedom of Information Act in order to obtain all data related to claims against orthopaedic surgery. It was found that the number of claims, and percentage of successful claims, has been constantly increasing over this period, with compensation paid of over £349 million.* Errors in clinical management accounted for the highest number of closed claims (2933 claims), costing over £119 million.* The level of compensation paid out has a significant financial impact on the NHS. Reforms need to be made in order to tackle the high cost of legal fees generated by these claims, which further drain the limited resources available to the NHS.
{"title":"Clinical negligence: an analysis of claims in trauma and orthopaedics in the UK","authors":"S. Ahmed","doi":"10.1302/2048-0105.46.360389","DOIUrl":"https://doi.org/10.1302/2048-0105.46.360389","url":null,"abstract":"The number of clinical negligence claims in the UK is constantly increasing. As a specialty, trauma and orthopaedic surgery has one of the highest numbers of negligence claims. 1 This study analyses NHS Litigation Authority (NHSLA) claims in trauma and orthopaedics between 2004 and 2014. A formal request was made to the NHSLA under the Freedom of Information Act in order to obtain all data related to claims against orthopaedic surgery. It was found that the number of claims, and percentage of successful claims, has been constantly increasing over this period, with compensation paid of over £349 million.* Errors in clinical management accounted for the highest number of closed claims (2933 claims), costing over £119 million.* The level of compensation paid out has a significant financial impact on the NHS. Reforms need to be made in order to tackle the high cost of legal fees generated by these claims, which further drain the limited resources available to the NHS.","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"28 1","pages":"31-35"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81009636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.1302/2048-0105.45.360391
L. Dodd, I. Sharpe, V. Mandalia, A. Toms, J. Phillips
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK.[1][1] This has prompted a drive for efficiency in healthcare provision in the UK, and in 2012, the Health and Social Care Act was introduced, heralding a fundamental change to the structure of the National Health Service, especially in the way that healthcare is funded in England.[2][2] What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.[3][3] We also seek to inform and educate the general orthopaedic community on this topic. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3
{"title":"Rationing of orthopaedic surgery in the UK","authors":"L. Dodd, I. Sharpe, V. Mandalia, A. Toms, J. Phillips","doi":"10.1302/2048-0105.45.360391","DOIUrl":"https://doi.org/10.1302/2048-0105.45.360391","url":null,"abstract":"The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK.[1][1] This has prompted a drive for efficiency in healthcare provision in the UK, and in 2012, the Health and Social Care Act was introduced, heralding a fundamental change to the structure of the National Health Service, especially in the way that healthcare is funded in England.[2][2] \u0000\u0000What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? \u0000\u0000In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.[3][3] We also seek to inform and educate the general orthopaedic community on this topic.\u0000\u0000 [1]: #ref-1\u0000 [2]: #ref-2\u0000 [3]: #ref-3","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"588 1","pages":"2-5"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85753104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-01DOI: 10.1302/2048-0105.45.360369
G. W. Clark, D. Wood
The use of robotics in arthroplasty surgery is expanding rapidly as improvements in the technology evolve. This article examines current evidence to justify the usage of robotics, as well as the future potential in this emerging field.
{"title":"Robotics in arthroplasty","authors":"G. W. Clark, D. Wood","doi":"10.1302/2048-0105.45.360369","DOIUrl":"https://doi.org/10.1302/2048-0105.45.360369","url":null,"abstract":"The use of robotics in arthroplasty surgery is expanding rapidly as improvements in the technology evolve. This article examines current evidence to justify the usage of robotics, as well as the future potential in this emerging field.","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"8 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81142922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-01DOI: 10.1302/2048-0105.45.360384
R. Starkie
With the worldwide recall of the DePuy ASR and field safety notices about other devices, together with articles in mainstream media, there has been a significant rise in compensation claims concerning the early failure of metal-on-metal (MOM) hip replacements and hip resurfacings. Readers with a MOM revision practice are likely to have patients already bringing legal action, or considering doing so, and they might also have an interest in medico-legal reporting in these cases. However, while some solicitors have regarded such cases as simple and straightforward, the cases can be very technically demanding and complex, with numerous pitfalls along the way. This paper seeks to discuss the different types of potential legal claims that can arise from failed MOM hips and considers some of the difficult issues that can arise. Where many people wish to sue the same defendant, regarding the same issue, the Court can issue a Group Litigation Order (GLO), which determines that all similar cases be run in parallel, with a lead firm of solicitors and a steering committee dealing with the common issues. This is to prevent the waste of legal costs and potential inconsistency that could arise if many law firms were dealing with the cases separately, in different ways, in different courts. At the time of writing, there are two such Orders: one relates to the DePuy Pinnacle MOM device, and the other to the Zimmer Durom/Metasul device. It is likely that there will be others in due course. Even where there is no GLO, law firms are likely to work together on similar cases, to share the workload of the common issues and to ensure a consistency of approach. Given that this is a class of products that is believed to have performed poorly, and there are publicised settlement schemes in the USA …
{"title":"Medico-legal issues relating to metal-on-metal hip devices","authors":"R. Starkie","doi":"10.1302/2048-0105.45.360384","DOIUrl":"https://doi.org/10.1302/2048-0105.45.360384","url":null,"abstract":"With the worldwide recall of the DePuy ASR and field safety notices about other devices, together with articles in mainstream media, there has been a significant rise in compensation claims concerning the early failure of metal-on-metal (MOM) hip replacements and hip resurfacings.\u0000\u0000Readers with a MOM revision practice are likely to have patients already bringing legal action, or considering doing so, and they might also have an interest in medico-legal reporting in these cases.\u0000\u0000However, while some solicitors have regarded such cases as simple and straightforward, the cases can be very technically demanding and complex, with numerous pitfalls along the way. This paper seeks to discuss the different types of potential legal claims that can arise from failed MOM hips and considers some of the difficult issues that can arise.\u0000\u0000Where many people wish to sue the same defendant, regarding the same issue, the Court can issue a Group Litigation Order (GLO), which determines that all similar cases be run in parallel, with a lead firm of solicitors and a steering committee dealing with the common issues. This is to prevent the waste of legal costs and potential inconsistency that could arise if many law firms were dealing with the cases separately, in different ways, in different courts.\u0000\u0000At the time of writing, there are two such Orders: one relates to the DePuy Pinnacle MOM device, and the other to the Zimmer Durom/Metasul device. It is likely that there will be others in due course.\u0000\u0000Even where there is no GLO, law firms are likely to work together on similar cases, to share the workload of the common issues and to ensure a consistency of approach.\u0000\u0000Given that this is a class of products that is believed to have performed poorly, and there are publicised settlement schemes in the USA …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"20 1","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82132757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-01DOI: 10.1302/2048-0105.44.360368
B. Ollivere
“ #Imatworkjeremy. Not just this weekend, in fact as a full time trauma consultant, I work one weekend a month with scheduled operating and clinical sessions from 8am to 10pm on Friday, Saturday and Sunday.” There has been something of a political storm in the UK health service recently, sparked by the allegation from the Secretary of State for Health, Jeremy Hunt, that senior and junior doctors are not working a full seven-day week, and the consequent lack of services is ‘placing lives at risk’. The ensuing public relations war between the British Medical Association and the Department of Health has been one of the biggest public spats of recent British political history, overtaking many of the social media channels and culminating in over 200 000 signatures to a petition calling for the resignation of Jeremy Hunt.1 The Government response is interesting. Citing a paper2 (although not …
{"title":"Political spin and public opinion: #Imatworkjeremy","authors":"B. Ollivere","doi":"10.1302/2048-0105.44.360368","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360368","url":null,"abstract":"“ #Imatworkjeremy. Not just this weekend, in fact as a full time trauma consultant, I work one weekend a month with scheduled operating and clinical sessions from 8am to 10pm on Friday, Saturday and Sunday.”\u0000\u0000There has been something of a political storm in the UK health service recently, sparked by the allegation from the Secretary of State for Health, Jeremy Hunt, that senior and junior doctors are not working a full seven-day week, and the consequent lack of services is ‘placing lives at risk’. The ensuing public relations war between the British Medical Association and the Department of Health has been one of the biggest public spats of recent British political history, overtaking many of the social media channels and culminating in over 200 000 signatures to a petition calling for the resignation of Jeremy Hunt.1\u0000\u0000The Government response is interesting. Citing a paper2 (although not …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91257392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-01DOI: 10.1302/2048-0105.44.360363
M. Reed, L. Hadfield-Law, D. Ryan
The British Orthopaedic Association’s Instructional Course 2015 took place over the weekend of 10-11 January at the Manchester Conference Centre, taking on a bold new format. Intended not only as a preparation for the FRCS(Orth), the instructional course is designed to provide a rolling programme of education suitable for trainees at all stages. Expert lectures were strongly supplemented by detailed case reviews and discussions, but the most significant change came in the introduction of critical condition Case-Based Discussions (CBD). Delegates were asked to choose four topics from a selection of a possible eight critical conditions, giving them the opportunity to achieve the standard required for Certificate of Completion of Training (CCT) in each. Notification of which CBDs were to be offered was sent out in advance of the …
{"title":"Meetings Roundup360: BOA Instructional Course","authors":"M. Reed, L. Hadfield-Law, D. Ryan","doi":"10.1302/2048-0105.44.360363","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360363","url":null,"abstract":"The British Orthopaedic Association’s Instructional Course 2015 took place over the weekend of 10-11 January at the Manchester Conference Centre, taking on a bold new format. Intended not only as a preparation for the FRCS(Orth), the instructional course is designed to provide a rolling programme of education suitable for trainees at all stages. Expert lectures were strongly supplemented by detailed case reviews and discussions, but the most significant change came in the introduction of critical condition Case-Based Discussions (CBD). Delegates were asked to choose four topics from a selection of a possible eight critical conditions, giving them the opportunity to achieve the standard required for Certificate of Completion of Training (CCT) in each. Notification of which CBDs were to be offered was sent out in advance of the …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"29 1","pages":"36-36"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77974450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-01DOI: 10.1302/2048-0105.44.360367
A. McBride, S. Nicol, F. Monsell
The Gough-Stewart platform (GSP) is a variable strut, programmable octahedral hexapod that uses six computer-controlled linear actuators to support a moveable base. These devices have been developed for a wide range of commercial uses including flight and vehicle simulators, high-precision tools, mining machines and medical instruments including programmable external fixators. The prototype hexapod external was introduced in France in 1986 and improvements in component design and computer algorithms have broadened the clinical repertoire of these devices. An increase in the number of available systems is expected in the next 18 months, owing to the expanding indications for this technology, in addition to termination of long standing patent arrangements and the associated commercial imperatives. These versatile platforms have clinical applications in acute fracture fixation; deformity surgery and limb salvage and provide an attractive combination of flexibility and ease of application. Contemporary orthopaedic practice is illustrated by two-dimensional radiological images, presented in standard anteroposterior and medio-lateral orthogonal planes. These are simplified ‘two axis’ representations of complex three-dimensional objects. It would not be possible to use an automated device to predictably reconstruct a deformed bone without the ability to mathematically describe the positions of the individual components. Pythagoras (c.570 BCE – c.495 BCE) and Euclid (c.300 BCE) are credited with defining the fundamentals of 2D and 3D geometry, and this was refined by Appolonius (c.262 BCE – c. 190 BCE), who anticipated Cartesian geometry by 1800 years. Pappus (c. A.D. 290 – c. 350) introduced a formalised approach to this area of mathematics and described a form of geometry that was not based on the concept of distance. This began with the study of the relationship between points and lines in 2D space and developed into the discipline of projective geometry. The introduction of realism in art in the Italian Renaissance relied on …
{"title":"The programmable hexapod: Historical perspective, theoretical basis and relevance to orthopaedic practice","authors":"A. McBride, S. Nicol, F. Monsell","doi":"10.1302/2048-0105.44.360367","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360367","url":null,"abstract":"The Gough-Stewart platform (GSP) is a variable strut, programmable octahedral hexapod that uses six computer-controlled linear actuators to support a moveable base. These devices have been developed for a wide range of commercial uses including flight and vehicle simulators, high-precision tools, mining machines and medical instruments including programmable external fixators.\u0000\u0000The prototype hexapod external was introduced in France in 1986 and improvements in component design and computer algorithms have broadened the clinical repertoire of these devices. An increase in the number of available systems is expected in the next 18 months, owing to the expanding indications for this technology, in addition to termination of long standing patent arrangements and the associated commercial imperatives. \u0000\u0000These versatile platforms have clinical applications in acute fracture fixation; deformity surgery and limb salvage and provide an attractive combination of flexibility and ease of application.\u0000\u0000Contemporary orthopaedic practice is illustrated by two-dimensional radiological images, presented in standard anteroposterior and medio-lateral orthogonal planes. These are simplified ‘two axis’ representations of complex three-dimensional objects. It would not be possible to use an automated device to predictably reconstruct a deformed bone without the ability to mathematically describe the positions of the individual components.\u0000\u0000Pythagoras (c.570 BCE – c.495 BCE) and Euclid (c.300 BCE) are credited with defining the fundamentals of 2D and 3D geometry, and this was refined by Appolonius (c.262 BCE – c. 190 BCE), who anticipated Cartesian geometry by 1800 years. Pappus (c. A.D. 290 – c. 350) introduced a formalised approach to this area of mathematics and described a form of geometry that was not based on the concept of distance. This began with the study of the relationship between points and lines in 2D space and developed into the discipline of projective geometry.\u0000\u0000The introduction of realism in art in the Italian Renaissance relied on …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"80 1","pages":"8-11"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90299921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-01DOI: 10.1302/2048-0105.44.360351
B. Ollivere
Sometimes new concepts and ideas can come from the most unexpected of quarters. Ad Gandhe (Portsmouth Queen Alexandra) recently started his argument in a debate on distal radius fractures with the concept of Kaizen. A word which may sound to you like it did to me, surprisingly familiar, having been brought into the English subconscious by David Brailsford, the TeamGB cycling coach. I was slightly surprised it had found its way onto an AO Advances course – but Ad gave some surprisingly good arguments as to why it is essential in surgery. The Japanese concept is that of ‘accumulation of margin gain’. The British Cycling Team used it with resounding success, as have Team Sky in the recent Tours. The concept is that whilst a small individual variable may make no difference to the overall outcome (say …
{"title":"Kaizen and the ‘accumulation of marginal gains’","authors":"B. Ollivere","doi":"10.1302/2048-0105.44.360351","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360351","url":null,"abstract":"Sometimes new concepts and ideas can come from the most unexpected of quarters. Ad Gandhe (Portsmouth Queen Alexandra) recently started his argument in a debate on distal radius fractures with the concept of Kaizen. A word which may sound to you like it did to me, surprisingly familiar, having been brought into the English subconscious by David Brailsford, the TeamGB cycling coach. I was slightly surprised it had found its way onto an AO Advances course – but Ad gave some surprisingly good arguments as to why it is essential in surgery. The Japanese concept is that of ‘accumulation of margin gain’. The British Cycling Team used it with resounding success, as have Team Sky in the recent Tours. The concept is that whilst a small individual variable may make no difference to the overall outcome (say …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"35 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89401456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-01DOI: 10.1302/2048-0105.42.360352
S. Nicol, M. Jackson, F. Monsell
This review explores recent advances in fixator design and used in contemporary orthopaedic practice including the management of bone loss, complex deformity and severe isolated limb injury.
{"title":"Recent advances in external fixation","authors":"S. Nicol, M. Jackson, F. Monsell","doi":"10.1302/2048-0105.42.360352","DOIUrl":"https://doi.org/10.1302/2048-0105.42.360352","url":null,"abstract":"This review explores recent advances in fixator design and used in contemporary orthopaedic practice including the management of bone loss, complex deformity and severe isolated limb injury.","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"44 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79412238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-01DOI: 10.1302/2048-0105.44.360366
M. Foy
Complications of hip and knee arthroplasty are frequently a source of litigation. The circumstances surrounding the complication - and whether it results from substandard care - need to be opined upon by a surgeon with considerable experience in that field. The subject was reported by McWilliams et al1 from a review of the records of the NHS Litigation Authority (NHSLA) in the UK. However, hip and knee arthroplasty is also a source of interest in some personal injury claims, particularly after tibial plateau and acetabular fractures. Legal advisers are usually interested in four things: *What is the likelihood of arthroplasty in the future? *When is it likely to be required? *What is the likely outcome, i.e. is the outcome similar in nature to arthroplasty for non-traumatic osteoarthritis? What is the likelihood of a revision being required in the patient/claimant’s lifetime? *If the patient/claimant is still in employment, how much time will they lose from work and how likely are they to get back to work? All orthopaedic surgeons are aware that the decision to recommend joint arthroplasty for a painful symptomatic hip/knee joint is very much a quality of life decision. This applies in both the post-traumatic and non-traumatic situation. A proper risk/benefit analysis needs to be conducted with the patient. The likelihood of post-traumatic arthritis developing after hip or knee injury depends upon the precise nature of the original injury and the adequacy of the initial surgery, if the fracture was treated operatively. Following analysis of the case, the expert should be in a position to make an educated estimate as to whether and when arthroplasty will be required in the future on the basis …
{"title":"Hip and knee arthroplasties and their significance in personal injury practice","authors":"M. Foy","doi":"10.1302/2048-0105.44.360366","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360366","url":null,"abstract":"Complications of hip and knee arthroplasty are frequently a source of litigation. The circumstances surrounding the complication - and whether it results from substandard care - need to be opined upon by a surgeon with considerable experience in that field. The subject was reported by McWilliams et al1 from a review of the records of the NHS Litigation Authority (NHSLA) in the UK.\u0000\u0000However, hip and knee arthroplasty is also a source of interest in some personal injury claims, particularly after tibial plateau and acetabular fractures. Legal advisers are usually interested in four things:\u0000\u0000*What is the likelihood of arthroplasty in the future?\u0000\u0000*When is it likely to be required?\u0000\u0000*What is the likely outcome, i.e. is the outcome similar in nature to arthroplasty for non-traumatic osteoarthritis? What is the likelihood of a revision being required in the patient/claimant’s lifetime?\u0000\u0000*If the patient/claimant is still in employment, how much time will they lose from work and how likely are they to get back to work?\u0000\u0000All orthopaedic surgeons are aware that the decision to recommend joint arthroplasty for a painful symptomatic hip/knee joint is very much a quality of life decision. This applies in both the post-traumatic and non-traumatic situation. A proper risk/benefit analysis needs to be conducted with the patient. The likelihood of post-traumatic arthritis developing after hip or knee injury depends upon the precise nature of the original injury and the adequacy of the initial surgery, if the fracture was treated operatively. Following analysis of the case, the expert should be in a position to make an educated estimate as to whether and when arthroplasty will be required in the future on the basis …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"19 1","pages":"39-40"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74841496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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