Analysis of Medical Malpractice Outcomes for Sports Orthopedic Procedures.

Orthopedic sports medicine surgeons are especially vulnerable to litigation, largely because of high patient expectations in the setting of complex surgeries. Understanding the factors associated with litigation may reduce physician risk as well as optimize patient satisfaction and outcomes. We used a national medicolegal database to search for medical malpractice verdicts and out-of-court settlements involving common sports injuries and their surgical management between January 1, 2000, and January 1, 2018. Univariate analysis was performed to identify predictors of case outcome and monetary awards. We identified 777 cases, but only 328 met the inclusion criteria. Of the 328 cases included in our study, 231 (70.4%) resulted in a defendant verdict, 75 (22.9%) resulted in a plaintiff verdict, and 22 (6.7%) resulted in a settlement. The most common reason for litigation was intraoperative error (183 cases, 55.8%). No statistically significant difference was found between monetary awards for plaintiff verdicts vs settlements (mean award of $1.29 million and $0.72 million, respectively, P=.07). Cases in which the plaintiff claimed neurovascular injury were significantly more likely to result in a higher monetary award (mean award of $2.37 million, P=.02). Cases involving an incorrect surgical site were significantly less likely to result in a defendant outcome, with 7 of 12 cases (58.3%) leading to a plaintiff outcome (P=.047). With more than two-thirds of cases resulting in a defendant verdict, many suits result in a favorable outcome for practitioners. Intraoperative error is the most common reason for litigation, and neurovascular injury resulted in the highest monetary payouts. Vigilance to avoid these events may improve patient outcomes and decrease liability to practitioners. [Orthopedics. 2022;45(1):e47-e52.].

Trends in Operative Time and Short-Term Outcomes After Conventional and Navigated Total Knee Arthroplasty.

BACKGROUND: Adoption of navigated total knee arthroplasty (Nav-TKA) is increasing. However, it has been suggested that a perceived decrease in surgical efficiency and a lack of proven superior functional outcomes associated with Nav-TKA have hindered its widespread adoption. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients who had undergone TKA with or without navigation between 2012 and 2018. Patients were further subclassified based on the type of navigation used, image-guided or imageless. Multivariate logistic regression was used to compare operative time and 30-day complication rates between conventional TKA (Conv-TKA) and Nav-TKA with and without image guidance. RESULTS: A total of 316,210 Conv-TKAs and 8554 Nav-TKAs (8270 imageless, 284 image-guided) were identified. Across the study period, the use of Nav-TKA was associated with a 1.5-minute increase in operative time. However, the overall time burden decreased over the study period, and by 2018, the mean operative time for Nav-TKA was 2.4 minutes less than that of Conv-TKA. Compared with Conv-TKA, Nav-TKA was associated with decreased rates of postoperative transfusion and surgical site complications but a similar incidence of systemic thromboembolism. CONCLUSIONS: This is the first large-scale database study to examine the differences in operative time between Conv-TKA and Nav-TKA. The time burden associated with Nav-TKA decreased over the study period and even reversed by 2018. Nav-TKA was associated with lower rates of postoperative transfusion and surgical site complications. Further studies are needed to evaluate the long-term and functional outcomes between conventional and navigated knee arthroplasty techniques.