Consent process for elective total hip and knee arthroplasty

PURPOSE: To assess the consent process for elective primary total hip replacement (THR) and total knee replacement (TKR) in our hospital.

METHODS: Consent processes of 47 THR and 53 TKR patients performed by 11 surgeons were reviewed. Complications that were documented were recorded, as was the grade of surgeon (consultant or specialist trainee) performing consent, and the location at which this took place. Comparisons were made between rates of documented, clinically significant complications discussed during consent, and those listed in the British Orthopaedic Association (BOA), in the literature, and other joint registries.

RESULTS: The consent processes of 37, 57, and 6 patients were conducted by consultants, specialist trainees, and both, respectively. 13% and 21% of THR patients had 'revision' and 'heterotropic ossification', respectively, documented as complications, neither of which were listed on the BOA consent form. Similarly 4% and 11% of TKR patients had 'revision' and 'dissatisfaction', respectively, documented as complications, neither of which were listed on the BOA consent form. In 23% of THR and 32% of TKR patients, none of the BOA-listed complications was documented. In 13% of THR and 15% of TKR patients, no complications were documented. In 13% of THR and 17% of TKR patients, only nonspecific descriptions of complications (e.g. morbidity, mortality and medical complications) were used in their consent forms.

CONCLUSION: Documentation of complications for THR and TKR patients was often incomplete and variable. The use of structured, procedure-specific consent forms is recommended.