Implementation of hip replacement surgery recommendations: a qualitative study of orthopaedic surgeons' perspectives

Total hip replacement is a common surgical procedure in which the 'ball' and 'socket' components of the hip joint are replaced with implants. The HipHOP study (Hip arthroplasty with Hybrid Or cemented implants: Patient reported outcomes) evaluated the feasibility of conducting a randomised controlled trial of two implant types. Qualitative research was embedded within the HipHOP study and aimed to understand factors which might affect the implementation of a future trial's findings.

Semi-structured qualitative interviews were conducted by telephone with sixteen orthopaedic surgeons. Purposive sampling ensured inclusion of surgeons who did and did not agree to their patients being included in the feasibility trial at two hospital sites, and also surgeons at a further two sites which were not involved in the feasibility trial. An inductive, thematic analysis was conducted, structured using the Framework approach. Findings were mapped to the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR).

To facilitate implementation of trial findings, it seemed important that advice be based on good quality research evidence showing clear benefits to the recommended approach and be supported by trusted professional organisations. Participants also considered the influence of surgeons' personal surgical results, recognising that outcomes may be affected by an individual surgeon's training and experience with an implant type. The importance of enabling surgeons to gain necessary skills was highlighted. The TDF seemed to be particularly valuable in understanding factors underlying implementation behaviour in this context, with the CFIR showing potential to contribute to understanding within some areas.

For a trial's findings to be influential in changing practice, it seems that: the trial needs to be well-designed and provide clear, strong findings; surgeons need to believe that changing practice will improve their personal outcomes; and suitable training opportunities need to be provided where surgeons lack experience using a recommended implant type. TRIAL REGISTRATION: Registered 19/02/2021, ISRCTN11097021.