WHAT INFLUENCES HIP SURGEONS’ DECISION-MAKING ABOUT FIXATION? A QUALITATIVE STUDY OF SURGEONS’ EXPERIENCES AND BELIEFS

As part of the HIPPY research programme we have undertaken a qualitative interview study to explore UK orthopaedic surgeons’ experiences and beliefs relating to decision-making about implant fixation types for patients who require a Total Hip Replacement, and to identify potential barriers and facilitators to changing of fixation practices amongst UK surgeons. The HIPPY programme aims to find out which implants are best for patients under 70 years of age and includes a randomised controlled trial (RCT) comparing different fixation types. There has been little empirical investigation of how orthopaedic surgeons make decisions about implant fixation, or exploration of the factors that influence and inform fixation choice for their patients, and the relative importance of these factors. This qualitative study aims to inform the HIPPY RCT and aid the implementation of its findings. In-depth qualitative interviews with UK-based consultant hip surgeons. Potential participants were invited through a national online survey of hip surgeons which opened in Jan 2024, facilitated by the British Hip Society. Interviews were completed with 19 surgeons between June and November 2024 representing 16 centres. Purposive sampling ensured that the sample reflected the breadth of fixation philosophies practiced in the UK. Preliminary findings from our ongoing iterative thematic analysis identify that surgeons’ fundamental aim is the achievement of a well reconstructed and long-lasting hip and choices about fixation are made in support of this. Important influences on surgeons’ fixation choices included training; published research and personal NJR data; patients’ age, bone quality and anatomy; and accumulated surgical experience. Both surgeons who were ‘cement-preferring’ and ‘cementless-preferring’ for younger patients perceived that their fixation choices were cost-effective. Surgeons described multiple influences on decision-making about fixation. Surgeons will consider new RCT findings alongside their own established practice and personal NJR outcome metrics, before considering changes to their fixation choices.