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[Decision for total hip arthroplasty-the surgeons' view]
Anne Postler1, Cornelia Lützner2, Toni Lange2
1UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland. Anne.postler@ukdd.de.
German surgeons prioritize patient pain, function loss, and conservative treatment failure when recommending total hip arthroplasty (THA). Contraindications like active infection are key, though morbid obesity isn't universally a deterrent for THA.
Area of Science:
- Orthopaedic Surgery
- Rheumatology
- Patient Management
Background:
- Total hip arthroplasty (THA) decisions lack standardized research-based criteria.
- Current recommendations for THA are often based on subjective factors rather than established guidelines.
- Understanding surgeons' decision-making processes is crucial for improving patient care in hip osteoarthritis.
Purpose of the Study:
- To analyze the specific criteria German orthopaedic and trauma surgeons use for recommending THA.
- To identify key patient-reported outcomes and radiological findings influencing THA decisions.
- To investigate factors considered contraindications for THA among German surgeons.
Main Methods:
- A nationwide survey was conducted among 218 orthopaedic and trauma surgeons in Germany.
- Data collection occurred between October 2019 and July 2020.
- 147 completed questionnaires were analyzed to determine decision criteria for THA.
Main Results:
- Pain (99%), limited movement (99%), and impaired walking (97%) were primary criteria for THA.
- Failure of conservative treatments like analgesics and physical therapy strongly influenced THA recommendations (97%).
- Active infection (96%) was a major contraindication, while morbid obesity (BMI ≥ 40 kg/m²) was not consistently viewed as such (48%).
Conclusions:
- Surgeons' current practices align with national and international discussions on THA recommendations.
- Patient-centric factors (pain, function, subjective burden) and conservative treatment outcomes are paramount.
- While infections are clear contraindications, the role of morbid obesity in THA decisions requires further clarification.
