Factors influencing preferred fixation method in total hip replacement –a national survey of practice with consultant orthopaedic surgeons in the UK

Aims:
To conduct a national survey of UK consultant hip surgeons to explore surgeons’ practice and factors influencing choice of implant fixation for primary elective total hip replacement (THR) patients.

Methods:
The online survey was conducted in 2024 with questions on surgeons’ practice, a rat-ing exercise with open text questions and a discrete choice experiment (DCE). In the DCE, sur-geons were presented with 10 randomly assigned patient profiles described by age, sex, activity level, risk of medical problems, and perceived risk of fracture, and were asked to choose their preferred fixation method (cemented, uncemented, or hybrid) for each.

Results:
101 consultants performing on average 121 (SD 81) primary elective THRs annually for 12.5 years (SD 8.5) completed the survey. For patients under 70, 60% of consultants would use hybrid, 31% uncemented and 9% cemented implants. For patients 70+, 55% would use hybrid, 33% cemented, 11% uncemented, and 1% reverse hybrid. In the DCE, the most influential patient characteristics were patient age and activity level. For a “moderately active” male patient, the probability of surgeons choosing a cemented implant was 10% at the age of 65 and 39% at the age of 85. These probabilities were 15% and 47% for a female patient. Increased perceived fracture risk decreased the probability of choosing an uncemented implant. 24 surgeons chose the same implant regardless of patient profile. In the rating exercise, the most influential factors besides patient characteristics were revision rate, personal practice audit and published evidence/guidelines. Analysis of free text responses identified further important influencing factors such as patient’s anatomy, bone quality, and surgeons’ training, skill and experience.

Conclusion:
This is the largest survey of UK consultant hip surgeons providing an understanding of drivers of implant choices. Findings will inform the implementation of implant research find-ings in real-world surgeons’ practice.