Perceived Risk of Elective Total Hip Arthroplasty: A Brazilian Hip Society Survey

As total hip arthroplasty (THA) has become more common and widely available, candidates now often present with multiple risk factors that increase the risk of complications, directly impacting the cost of surgery and provider compensation. The present study was designed to better understand the impact of these factors and the perceptions of hip surgeons in Brazil.

All 880 full members of the Brazilian Hip Society (SBQ) were invited to complete an online questionnaire on preoperative risk factors, adapted from the previous American Association of Hip and Knee Surgeons survey. Statistical analyses of survey response data were performed.

A total of 398 responses were received (45.2% of SBQ members). Most (81.7%) work in high-complexity hospitals; 46% have more than 15 years of experience in THA; and 30.2% perform more than 100 THAs/year (47% perform 40 to 100/year). Overall, 56.5% restrict THA eligibility based on modifiable risk factors: 76.6% view malnutrition and 65.8% view poorly controlled diabetes as factors precluding THA; most (89.2%) recommend waiting six to 24 months after bariatric surgery. Although 59.5% of respondents turn down candidates who abuse alcohol, 80.9% are willing to operate on smokers and 75.6% on opioid users. Advanced age was not a relevant factor for 87.2, and 71.1% perceive risk as equal in men and women. Among respondents who restrict THA eligibility, 78% do so based on personal experience or literature, while 32.6% follow the opinion of the patient's primary clinician. 90.4% believe risk-based compensation would expand access to THA.

Compared to their peers in Latin America, Asia, Europe, and the United States, SBQ members have a largely similar perception of restrictions to performing THA, but are more willing to operate on smokers and more likely to defer THA in postbariatric patients. Nearly all favor adjusting surgeon compensation to take patient risk factors into account.