Factors influencing prosthesis selection and variation: a national survey of orthopaedic surgeons in Ireland

Failures in implant selection, due to unfamiliarity, limited cost transparency, or a lack of reported outcome data on implants can contribute to increased morbidity and unnecessary revision surgeries, thus imposing further strain on healthcare resources.National arthroplasty registries have emerged as critical tools in evaluating implant performance and guiding safer prosthesis selection.Countries such as Sweden, Australia, and the UK have demonstrated that registry engagement can lead to reduced revision rates, greater standardisation in care, and earlier identification of underperforming implants [4, 9, 10].In Ireland, the Irish National Orthopaedic Register (INOR) was established in 2014 with the aim of enabling data-driven quality assurance and outcome monitoring [1].However, the extent to which Irish orthopaedic surgeons actively consult or utilise registry data to inform their clinical decisions remains unclear.A further challenge is the persistent variation in implant choice observed across surgeons, institutions, and regions.While some degree of variation is appropriate, reflecting differences in patient anatomy, comorbidities, or activity level, variation may also arise from surgeon-related factors rather than patient need.International studies suggest that implant familiarity, perceived quality, autonomy, and training background frequently outweigh cost or registry considerations when selecting prostheses [5, 8].Irish Orthopaedic consultants, especially in the private sector, report considerable autonomy in implant choice, while trainees are often excluded from such decisions, limiting their exposure to cost-conscious and evidence-based selection frameworks.Although prosthesis procurement in Ireland is governed by national frameworks designed to promote consistency and cost-effectiveness, their influence on individual clinician behaviour remains poorly understood [8, 9].Additionally, in the private sector, oversight and standardisation are less robust.A lack of formal education in procurement practices, implant cost-awareness, and the principles of value-based