Karia Monil, Abouharb Alex, Sabharwal Sanjeeve, Mavroveli Stella, Cobb Justin
MSk Lab, Imperial College London, London, UK
MSk Lab, Imperial College London, London, UK.
BMJ Open. 2025 Jan 2;15(1):e088081. doi: 10.1136/bmjopen-2024-088081.
For total hip arthroplasty (THA) to be successful, surgeons need to make several decisions ranging from implant choice to impaction force. It is unclear, however, whether and how bone quality affects surgeon's decision-making and how surgeons evaluate bone quality.
This inductive/deductive qualitative hybrid study aims to explore the impact of bone quality on the decision-making of surgeons performing elective primary THA. This study will evaluate: (1) whether surgeons consider bone quality as an important factor for surgical decision-making; (2) how bone quality influences surgical decision-making; and (3) how surgeons assess bone quality preoperatively and intraoperatively.
This is a qualitative study, involving inductive/deductive hybrid thematic analysis.
Semistructured interviews were conducted virtually via Microsoft Teams and on hospital premises.
Purposive and snowball sampling methods were used to recruit consultant orthopaedic surgeons specialised in elective lower limb arthroplasty.
10 surgeons from eight centres in the UK were interviewed. Thematic saturation was achieved after eight interviews. 5 main themes and 13 subthemes were identified. Bone quality impacted decisions around preoperative planning, surgical procedure, implant choice, concerns of iatrogenic injury and hip biomechanics. Many surgeons (7/10) described changing surgical procedure based on their intraoperative assessment of bone quality. There was consensus that cemented femoral fixation is superior in patients with poor bone quality and on the importance of assessing radiographs preoperatively. There was, however, a lack of consensus on optimal acetabular fixation method, the radiographs metrics used to measure bone quality and attitudes towards current guidelines.
Bone quality has a significant impact on the decision-making of experienced arthroplasty surgeons, though there are significant limitations and divergence in current methods of assessing bone quality. Further work to identify intraoperative and preoperative imaging metrics that correlate with bone mechanical properties could enhance surgical decision-making.
为使全髋关节置换术（THA）取得成功，外科医生需要做出多项决策，从植入物选择到打压力度。然而，目前尚不清楚骨质量是否以及如何影响外科医生的决策，以及外科医生如何评估骨质量。
本归纳/演绎定性混合研究旨在探讨骨质量对择期初次全髋关节置换术外科医生决策的影响。本研究将评估：（1）外科医生是否将骨质量视为手术决策的重要因素;（2）骨质量如何影响手术决策;（3）外科医生如何在术前和术中评估骨质量。
这是一项定性研究，采用归纳/演绎混合主题分析。
通过Microsoft Teams进行虚拟半结构化访谈，并在医院进行现场访谈。
采用目的抽样和滚雪球抽样方法，招募专门从事择期下肢关节置换术的骨科顾问医生。
对来自英国八个中心的10名外科医生进行了访谈。在进行了8次访谈后达到了主题饱和。确定了5个主要主题和13个子主题。骨质量影响了术前规划、手术过程、植入物选择、医源性损伤担忧和髋关节生物力学等方面的决策。许多外科医生（7/10）表示会根据术中对骨质量的评估改变手术方式。大家一致认为，在骨质量较差的患者中，骨水泥型股骨固定更好，并且术前评估X线片很重要。然而，在最佳髋臼固定方法、用于测量骨质量的X线片指标以及对现行指南的态度方面，缺乏共识。
骨质量对经验丰富的关节置换外科医生的决策有重大影响，尽管目前评估骨质量的方法存在重大局限性和差异。进一步确定与骨力学性能相关的术中及术前影像学指标的工作，可能会改善手术决策。
