{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:01:26Z","timestamp":1780574486175,"version":"3.54.1"},"reference-count":25,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Injuries after primary total hip arthroplasty (THA) can be compensated through the National Swedish Patient Insurance Company (L\u00f6f). This study examined injury incidence, types, consequences, and subgroup differences in compensated claims following primary THA for osteoarthritis (OA) in Sweden over 10 years.Methods:\u00a0Data from L\u00f6f and the Swedish Arthroplasty Register were used for compensated claims following primary THA between 2012 and 2021. Injury incidence and subgroup differences by sex, age, OA diagnosis, and surgical volume were analyzed. Injury types, severity, reoperation rate, and surgical approach were evaluated. Absolute risk differences (ARD) and incidence rate ratios (IRR) were calculated.Results:\u00a01,343 injuries were followed up. The injury incidence was 1.3%. Injury rates were higher in patients &lt; 65 years than \u2265 65 years (ARD 0.2%, 95% confidence interval [CI] 0.1\u20130.3), in OA due to hip dysplasia compared with primary OA (IRR 1.78, CI 1.31\u20132.35), and at low- and medium-volume compared with high-volume hospitals (IRR 1.35, CI 1.11\u20131.64; IRR 1.27, CI 1.14\u20131.42). In surgery-related injuries (n = 1,251), infection (38%, CI 35\u201341) and nerve injury (22%, CI 20\u201325) were the most common injury types, and direct lateral incisions were more frequent than national reference proportions of all THAs during the study period (ARD 9%, CI 6\u201312). Permanent disability occurred in 74% (CI 72\u201377) of the claims, and the 2-year reoperation rate was 51% (CI 48\u201354) (0.4% of the total population).Conclusion:\u00a0The injury incidence after primary THA was 1.3% and frequently resulted in permanent disability and reoperation. Infection and nerve injury were the most common injury types. Higher injury rates in younger patients, hip dysplasia, and lower-volume hospitals highlight potential areas for prevention and increased awareness.<\/jats:p>","DOI":"10.2340\/17453674.2026.45971","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:12:46Z","timestamp":1780571566000},"source":"Crossref","is-referenced-by-count":0,"title":["Patient injuries after total hip arthroplasty for osteoarthritis in Sweden over 10 years: a cohort study based on 1,343 patients"],"prefix":"10.2340","volume":"97","author":[{"given":"Siri","family":"Heijbel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Rahmanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1152-8700","authenticated-orcid":false,"given":"Pelle","family":"Gustafson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-6595","authenticated-orcid":false,"given":"Harald","family":"Brismar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4053-7358","authenticated-orcid":false,"given":"Annette","family":"W-Dahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9258-3156","authenticated-orcid":false,"given":"Margareta","family":"Hedstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"157852","doi-asserted-by":"crossref","unstructured":"Khan N, Petersen M M, Mikkelsen K L, Schr\u00f8der H M. No\u2011fault compensation from the Patient Compensation Association in Denmark after primary total hip replacement in Danish hospitals 2005-2017. J Arthroplasty 2020; 35: 1784-91. doi: 10.1016\/j.arth.2020.02.042.","DOI":"10.1016\/j.arth.2020.02.042"},{"key":"157853","doi-asserted-by":"crossref","unstructured":"Aae T F, Jakobsen R B, Bukholm I R K, Fenstad A M, Furnes O, Randsborg P\u2011H. Compensation claims after hip arthroplasty surgery in Norway 2008\u20132018. Acta Orthop 2021; 92: 311-15. doi: 10.1080\/17453674.2021.1872901.","DOI":"10.1080\/17453674.2021.1872901"},{"key":"157854","doi-asserted-by":"crossref","unstructured":"Helkamaa T, Hirvensalo E, Huhtala H, Remes V. Patient injuries in primary total hip replacement. Acta Orthop 2016; 87: 209-17. doi: 10.3109\/17453674.2015.1135662.","DOI":"10.3109\/17453674.2015.1135662"},{"key":"157855","doi-asserted-by":"crossref","unstructured":"Pukk\u2011H\u00e4renstam K, Ask J, Brommels M, Thor J, Pe\u00f1aloza R V, Gaffney F A. Analysis of 23 364 patient\u2011generated, physician\u2011reviewed malpractice claims from a non\u2011tort, blame\u2011free, national patient insurance system: lessons learned from Sweden. BMJ Qual Saf 2008; 17: 259-63. doi: 10.1136\/qshc.2007.022897.","DOI":"10.1136\/qshc.2007.022897"},{"key":"157856","unstructured":"Swedish Arthroplasty Register (SAR) Annual Report 2022. Report No. 978\u201191\u2011986612\u20113\u20111. Available from: https:\/\/sar.registercentrum.se\/about-the-register\/annual-reports\/p\/SJW4-ZGyo"},{"key":"157857","unstructured":"L\u00f6f - en patientf\u00f6rs\u00e4kring f\u00f6r alla. [In English]. Available from: https:\/\/lof.se\/language (accessed March 31, 2026)."},{"key":"157858","doi-asserted-by":"crossref","unstructured":"Christensen R, Ranstam J, Overgaard S, Wagner P. Guidelines for a structured manuscript: statistical methods and reporting in biomedical research journals. Acta Orthop 2023; 94: 243-9. doi: 10.2340\/17453674.2023.11656.","DOI":"10.2340\/17453674.2023.11656"},{"key":"157859","doi-asserted-by":"crossref","unstructured":"Vink M C, Peters R M, van Dooren B, Deen A, van Steenbergen L N, Schreurs B W, et al. High-volume hospitals do not perform better than low-volume hospitals in septic and aseptic revision total hip arthroplasty: an analysis of re-revision risk and mortality based on the Dutch Arthroplasty Register. Acta Orthop 2025; 96; 625-31. doi: 10.2340\/17453674.2025.44331.","DOI":"10.2340\/17453674.2025.44331"},{"key":"157860","doi-asserted-by":"crossref","unstructured":"Katz J N, Losina E, Barrett J, Phillips C B, Mahomed N N, Lew R A, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am 2001; 83: 1622-9. doi: 10.2106\/00004623\u2011200111000\u201100002.","DOI":"10.2106\/00004623-200111000-00002"},{"key":"157861","doi-asserted-by":"crossref","unstructured":"Shetty T, Nguyen J T, Wu A, Sasaki M, Bogner E, Burge A, et al. Risk factors for nerve injury after total hip arthroplasty: a case\u2011control study. J Arthroplasty 2019; 34: 151-6. doi: 10.1016\/j.arth.2018.09.008.","DOI":"10.1016\/j.arth.2018.09.008"},{"key":"157862","doi-asserted-by":"crossref","unstructured":"Losina E, Barrett J, Mahomed N N, Baron J A, Katz J N. Early failures of total hip replacement: effect of surgeon volume. Arthritis Rheum 2004; 50: 1338-43. doi: 10.1002\/art.20148.","DOI":"10.1002\/art.20148"},{"key":"157863","doi-asserted-by":"crossref","unstructured":"Jolb\u00e4ck P, Rolfson O, Cnudde P, Odin D, Malchau H, Lindahl H, et al. High annual surgeon volume reduces the risk of adverse events following primary total hip arthroplasty: a registry\u2011based study of 12,100 cases in Western Sweden. Acta Orthop 2019; 90: 153-8. doi: 10.1080\/17453674.2018.1554418.","DOI":"10.1080\/17453674.2018.1554418"},{"key":"157864","doi-asserted-by":"crossref","unstructured":"Koltsov J C B, Marx R G, Bachner E, McLawhorn A S, Lyman S. Risk\u2011based hospital and surgeon\u2011volume categories for total hip arthroplasty. J Bone Joint Surg Am 2018; 100: 1203-8. doi: 10.2106\/JBJS.17.00967.","DOI":"10.2106\/JBJS.17.00967"},{"key":"157865","doi-asserted-by":"crossref","unstructured":"Kasina P, Enocson A, Lindgren V, Lapidus L J. Patient claims in prosthetic hip infections: a comparison of nationwide incidence in Sweden and patient insurance data. Acta Orthop 2018; 89: 394-8. doi: 10.1080\/17453674.2018.1477708.","DOI":"10.1080\/17453674.2018.1477708"},{"key":"157866","doi-asserted-by":"crossref","unstructured":"Magn\u00e9li M, Unbeck M, Samuelsson B, Rogmark C, Rolfson O, Gordon M, et al. Only 8% of major preventable adverse events after hip arthroplasty are filed as claims: a Swedish multi\u2011center cohort study on 1,998 patients. Acta Orthop 2020; 91: 20-5. doi: 10.1080\/17453674.2019.1677382.","DOI":"10.1080\/17453674.2019.1677382"},{"key":"157867","doi-asserted-by":"crossref","unstructured":"J\u00e4rvelin J, H\u00e4kkinen U, Rosenqvist G, Remes V. Factors predisposing to claims and compensations for patient injuries following total hip and knee arthroplasty. Acta Orthop 2012; 83: 190-6. doi: 10.3109\/17453674.2012.672089.","DOI":"10.3109\/17453674.2012.672089"},{"key":"157868","doi-asserted-by":"crossref","unstructured":"Grant S, Pincus D, Ruangsomboon P, Lex J, Sheth U, Ravi B. Sex differences in complications following total hip arthroplasty: a population\u2011based study. J Arthroplasty 2024; 39: 3004-8. doi: 10.1016\/j.arth.2024.05.062.","DOI":"10.1016\/j.arth.2024.05.062"},{"key":"157869","doi-asserted-by":"crossref","unstructured":"Hasija R, Kelly J J, Shah N V, Newman J M, Chan J J, Robinson J, et al. Nerve injuries associated with total hip arthroplasty. J Clin Orthop Trauma 2018; 9: 81-6. doi: 10.1016\/j.jcot.2017.10.011.","DOI":"10.1016\/j.jcot.2017.10.011"},{"key":"157870","doi-asserted-by":"crossref","unstructured":"Skoogh O, Tsikandylakis G, Mohaddes M, Nemes S, Odin D, Grant P, et al. Contemporary posterior surgical approach in total hip replacement: Still more reoperations due to dislocation compared with direct lateral approach? An observational study of the Swedish Hip Arthroplasty Register including 156,979 hips. Acta Orthop 2019; 90: 411-16. doi: 10.1080\/17453674.2019.1610269.","DOI":"10.1080\/17453674.2019.1610269"},{"key":"157871","doi-asserted-by":"crossref","unstructured":"Pedersen A B, Mehnert F, Havelin L I, Furnes O, Herberts P, K\u00e4rrholm J, et al. Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age: results from the Nordic Arthroplasty Register Association. Osteoarthritis Cartilage 2014; 22: 659-67. doi: 10.1016\/j.joca.2014.03.005.","DOI":"10.1016\/j.joca.2014.03.005"},{"key":"157872","doi-asserted-by":"crossref","unstructured":"Moore M C, Dubin J A, Mon\u00e1rrez R, Bains S S, Hameed D, Nace J, et al. Cemented versus cementless femoral fixation for total hip arthroplasty following osteoarthritis. 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Association of resident training with complication risk in total hip and knee arthroplasty: a systematic review and meta-analysis. Acta Orthop 2025; 96; 850-6. doi: 10.2340\/17453674.2025.43905.","DOI":"10.2340\/17453674.2025.43905"},{"key":"157876","doi-asserted-by":"crossref","unstructured":"J\u00e4rvelin J, H\u00e4kkinen U. Can patient injury claims be utilised as a quality indicator? 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