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What influences UK-practising consultant hip surgeons' decision-making about implant fixation? An interview study
Cecily Palmer1, Petra Baji2, Michael R Whitehouse2
1Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building Level 1, University of Bristol, Southmead Hospital, Bristol, UK cecily.palmer@bristol.ac.uk.
BMJ Open
|July 10, 2026
Summary
UK hip surgeons consider patient characteristics, training, and personal experience when choosing implant fixation for total hip replacement. There is equipoise regarding the optimal fixation method for young, uncomplicated patients.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Decision-Making
Background:
- Total hip replacement (THR) involves selecting implant fixation: cemented, hybrid, or uncemented.
- Surgeon decision-making for THR fixation in patients under 70 is complex and multifactorial.
- Understanding these factors is crucial for optimizing patient outcomes and surgical practice.
Purpose of the Study:
- To explore UK consultant hip surgeons' views on implant fixation choices for THR in patients under 70.
- To identify key factors influencing the decision-making process regarding cemented, hybrid, and uncemented fixation.
Main Methods:
- Qualitative semistructured interview study with 20 UK consultant hip surgeons.
- Purposive sampling ensured representation of various fixation methods.
- Inductive thematic analysis of transcribed interviews to identify influential factors.
Main Results:
- Six themes emerged: patient characteristics, preferences/availability, training, evidence, personal experience, and secondary benefits (speed/cost).
- Patient bone quality, anatomy, age, comorbidities, and activity level significantly influenced fixation choice.
- Surgeons' training, skillset, and personal/National Joint Registry outcomes reinforced fixation preferences.
Conclusions:
- Surgeon decision-making for THR fixation is influenced by a combination of patient-specific factors, surgeon experience, and available evidence.
- Community equipoise exists among UK hip surgeons regarding the superior fixation method for young, uncomplicated patients.
