title: Knee arthroplasty and lawsuits: the experience in France.
abstract: OBJECTIVE
  Data regarding knee arthroplasty and lawsuit are scarce. With the expected increase in knee arthroplasty over the next 25 years, the number of claims might follow the same trend. Therefore, the most frequent causes of litigation after knee arthroplasty in France, and what is considered as malpractice by the expert, were determined.
  
  
  METHODS
  Over 8-year period, data gathered from a French private insurance company specializing in malpractice for private practitioners were analyzed. Demographics, type of knee arthroplasty, reason for claim, details of the legal procedure and the expert's decision were reviewed.
  
  
  RESULTS
  One hundred and five claims were processed by four jurisdictions. Most of the cases concerned primary total knee arthroplasty. Surgeons and anesthesiologists were charged in 84 and 16 % of claims, respectively. The most frequent causes of litigation were infection, neurological deficit and unsatisfactory result, whereas the most common reasons for the surgeon's liability, as stated by the expert, were delay in diagnosis or treatment of a complication, infection and technical error.
  
  
  CONCLUSIONS
  Our findings show that frequent complications are not those which raise most of the claims. Patients sue the surgeon when the outcome of the surgery is different from what they were expecting. An unsatisfactory result, according to the patient's point of view, is the second most frequent cause of claim.
  
  
  METHODS
  IV, Economic and Decision Analysis. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Diaconesses Croix-Saint-Simon Teaching Hospital, 125 rue d'Avron, 75020, Paris, France. emmanuel.gibon@gmail.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gibon
authors.affiliation: Mutuelle d'assurance du corps de santé français (MACSF), 10 cours du Triangle-de-l'Arche, TSA 40100, 92919, La Défense Cedex, Paris, France. thierry.farman@orange.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Farman
authors.affiliation: Department of Orthopaedic Surgery, Diaconesses Croix-Saint-Simon Teaching Hospital, 125 rue d'Avron, 75020, Paris, France. smarmor@hopital-dcss.org.
authors.forename: Simon
authors.initials: S
authors.lastname: Marmor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008318:Malpractice; D008875:Middle Aged
keywords: Complication; Knee arthroplasty; Lawsuit; Litigation