Research Article: Factors predisposing to claims and compensations for patient injuries following total hip and knee arthroplasty

Date Published: April 24, 2012

Publisher: Informa Healthcare

Author(s): Jutta Järvelin, Unto Häkkinen, Gunnar Rosenqvist, Ville Remes.


Factors associated with malpractice claims are poorly understood. Knowledge of these factors could help to improve patient safety. We investigated whether patient characteristics and hospital volume affect claims and compensations following total hip arthroplasty (THA) and knee arthroplasty (TKA) in a no-fault scheme.

A retrospective registry-based study was done on 16,646 THAs and 17,535 TKAs performed in Finland from 1998 through 2003. First, the association between patient characteristics—e.g., age, sex, comorbidity, prosthesis type—and annual hospital volume with filing of a claim was analyzed by logistic regression. Then, multinomial logistic regression was applied to analyze the association between these same factors and receipt of compensation.

For THA and TKA, patients over 65 years of age were less likely to file a claim than patients under 65 (OR = 0.57, 95% CI: 0.46–0.72 and OR = 0.65, CI: 0.53–0.80, respectively), while patients with increased comorbidity were more likely to file a claim (OR = 1.17, CI: 1.04–1.31 and OR = 1.14, CI: 1.03-1.26, respectively). Following THA, male sex and cemented prosthesis reduced the odds of a claim (OR = 0.74, CI: 0.60–0.91 and OR = 0.77, CI: 0.60–0.99, respectively) and volume of between 200 and 300 operations increased the odds of a claim (OR = 1.29, CI: 1.01–1.64). Following TKA, a volume of over 300 operations reduced the probability of compensation for certain injury types (RRR = 0.24, CI: 0.08–0.72).

Centralization of TKA to hospitals with higher volume may reduce the rate of compensable patient injuries. Furthermore, more attention should be paid to equal opportunities for patients to file a claim and obtain compensation.

Partial Text

Information on patients who had undergone primary THA or TKA at a public hospital (including some large health centers) in Finland between 1998 and 2003 was retrieved from the Hospital Discharge Register using mostly the same criteria that were used in a previous study on the cost-effectiveness of arthroplasty surgery (Mäkelä et al. 2011). Cases were included if the diagnosis codes indicated primary osteoarthritis of the hip (ICD-10 codes M16.0 or M16.1) together with a procedure code of THA (NFB30–NFB60 or NFB99, according to the Nordic Medico-Statistical Committee’s classification). With regard to TKA, the corresponding diagnosis code was M17.0 or M17.1, together with a procedure code of TKA (NGB10–NGB99).

In the logistic regression analyses regarding THA, patients who were over 65 years of age, men, and patients with a cemented prosthesis were less likely to file a claim and patients who had been operated on at a hospital with an annual volume of between 200 and 300 operations were more likely to file a claim. Likewise, regarding TKA, those patients who were over 65 years of age were less likely to file a claim. Furthermore, regarding both THA and TKA, a 1-unit increase in the Charlson index increased the odds of a claim by 17% and 14%, respectively (Table 2).

We found that elderly patients were less inclined to file claims than younger patients. Various explanations have been proposed for this previously, ranging from elderly patients’ lower economic loss from injuries to acceptance of poor outcomes at the end of one’s life (Studdert et al. 2000, Bismark et al. 2006, Järvelin et al. 2009). In contrast, the reason for the larger odds of patients with increased comorbidity filing a claim could be that individuals who are more sick are generally less content with their medical care and—based on their more extensive use of health services—may have better knowledge of various ways of complaining than healthier people (Jackson et al. 2001, Xiao and Barber 2008, Rahmqvist and Bara 2010). Even so, comorbidity did not have a statistically significant effect on receiving compensation.