Consent in elective joint replacement surgery: are we doing enough?

A substantial number of clinical negligence claims arise from a failure to adequately advise patients prior to surgery. It is important for surgeons at all levels to maintain good practice in obtaining consent and to recognize that the standards against which they are judged in litigation have changed in recent years. Consent is a process rather than an event and evidence of valid consent includes the surgeon's letters, oral and written information given to the patient and, to a limited extent, the consent form. We retrospectively audited the documentation relating to consent in the case notes of 50 patients undergoing elective joint replacement surgery between August 2004 and March 2005, and found that documentation was generally inadequate. We recommend that there should be national guidance on complications for standard elective joint replacement procedures. This could be incorporated into the best practice guidance on joint replacement surgery published by the British Orthopaedic Association.