Background: Litigation in Orthopaedic Surgery poses a significant financial challenge to healthcare systems. Orthopaedic-related claims accounted for 10.8% of the 10,900 total claims in the NHS in 2023/24, costing approximately £250 million. Yet, no extended analysis of Orthopaedic-related litigation trends has been conducted. This study examined NHS litigation data from 1996/97 to 2023/24 identifying trends, causes, and financial impact to provide actionable insights for improving clinical practice.
Methods: Orthopaedic-related claims data from NHS Resolution (NHSR; 1996/97–2023/24) were analysed under the Freedom of Information Act. The dataset, focused on closed claims with settlements, included causes, injury types, and payouts. Broader classifications were applied due to GDPR constraints. Non-parametric distributions were confirmed using the Shapiro-Wilk test. Subsequent analyses, using the Kruskal-Wallis tests, calculated significant differences between categories and across years.
Results: Between 1996/97 and 2023/24, 22,606 clinical negligence claims resulted in 14,702 settlements exceeding £2.2 billion, including £1.2 billion in damages. Musculoskeletal injuries were most frequent primary injuries (21%, £407.53 million), followed by unnecessary operations and postoperative pain (22%, £328.27 million). Neurological issues (8%) and poor outcomes (13%) accounted for £254.74 million and £129.14 million, respectively. Surgical errors (24%) caused the highest damages of the primary causes (£309.47 million), followed by failure or delayed treatment (23%, £277.02 million) and decision-making errors (22%, £287.57 million). Settlement values peaked in the early 2010s before declining, with significant differences in median claims, damages, and total payouts per annum (p < 0.001).
Conclusion: Between 1996/97 and 2023/24, over £2.2 billion was paid in settlements, with £1.2 billion in damages. Musculoskeletal injuries, surgical errors, and delayed treatment were leading causes, highlighting persistent clinical challenges. Although claim volumes and payouts have declined since 2011/12, improved consent and multidisciplinary meetings may offer potential opportunities to enhance patient outcomes and reduce litigation against Orthopaedic Surgeons in the NHS.
Supplementary Information: The online version contains supplementary material available at 10.1007/s00402-025-05957-y.
Keywords: Legal; Litigation; Malpractice; NHS; Orthopaedics.