Medical Malpractice in Orthopaedics: Why Awareness, Prevention, and Advocacy Matter

This post was written by Joseph A. Abboud, MD and Peter Boufadel, MD, two of the authors of the new Current Concepts Review article now in The Journal: Medical Malpractice Litigation in Orthopaedic Surgery in the United States. Risk Factors, Outcomes, and Strategies for Navigating Lawsuits, Prevention, and Reform. Their post is part of the new “Author 360” series on OrthoBuzz, offering author insights and perspectives on featured JBJS content.

Medical malpractice litigation remains an unfortunate reality that most orthopaedic surgeons hope never to face—but many eventually do. Practicing as an orthopaedic surgeon in Philadelphia, a region with a high and increasing prevalence of litigation, I (J.A.A.) have seen firsthand how the medicolegal climate influences daily clinical decision-making and contributes to defensive medicine. In our new JBJS Current Concepts Review, Medical Malpractice Litigation in Orthopaedic Surgery in the United States. Risk Factors, Outcomes, and Strategies for Navigating Lawsuits, Prevention, and Reform, we sought to better understand why claims occur, how they unfold, and how surgeons can protect both their patients and themselves.

Our review provides a practical, subspecialty-specific overview of malpractice litigation in orthopaedics, highlighting risk profiles, common allegations, and legal outcomes. High-risk procedures such as spine surgery, trauma care, and total joint arthroplasty were associated with higher claim rates and indemnity payments, often driven by allegations of surgical error, delayed diagnosis, or inadequate informed consent. One notable finding was that many claims did not involve clear deviations from the standard of care, reinforcing that adverse outcomes, unmet expectations, or communication breakdowns frequently drive litigation—not negligence alone. While most cases ultimately resolve in favor of the surgeon, the process often spans years and carries substantial emotional and professional consequences.

Navigating a malpractice claim can be daunting. Our review emphasizes practical strategies, including clear documentation, thoughtful communication following complications, early engagement with legal counsel, and avoidance of defensive or adversarial patient interactions. Importantly, these same principles form the foundation of malpractice prevention. Strong patient-surgeon relationships, setting realistic expectations, and robust informed consent discussions have repeatedly been shown to reduce litigation risk.

Finally, orthopaedic surgeons must recognize their role as advocates not only for themselves, but for their patients and the health-care system at large. Supporting initiatives such as alternative dispute resolution, safe-harbor protections, and communication-and-resolution programs may help reduce unnecessary litigation while preserving patient rights. Surgeons can engage in advocacy at local and national levels to help create a medicolegal environment that prioritizes learning, accountability, and high-quality care, rather than fear and defensiveness.

Joseph A. Abboud, MD is a Professor of Shoulder and Elbow Surgery at the Rothman Orthopaedic Institute and Thomas Jefferson University in Philadelphia, Pennsylvania.

Peter Boufadel, MD is a Postdoctoral Research Fellow in the Division of Shoulder and Elbow Surgery at the Rothman Orthopaedic Institute in Philadelphia.