307 The Impact of Bone Quality on Surgical Decision-Making in Elective Primary Total Hip Arthroplasty: A Qualitative Analysis

Abstract Aim This inductive/deductive qualitative hybrid study aims to explore the impact of bone quality on decision-making amongst surgeons performing elective primary Total Hip Arthroplasty (THA). Method Purposive and snowball sampling were used to recruit Consultant Orthopaedic Surgeons specialised in elective lower limb arthroplasty. Semi-structured interviews were conducted virtually and on Hospital premises, and audio was transcribed. An iterative inductive/deductive strategy was used to code interview transcripts, and thematic analysis was undertaken using NVivo software (Version 14.23.0), in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results There were 10 surgeons from eight centres in the United Kingdom interviewed. Thematic saturation was achieved after eight interviews. Five main themes, and 13 sub-themes were identified. Bone quality impacted decisions around preoperative planning, surgical procedure, implant choice, iatrogenic injury prevention, and hip biomechanics. Many surgeons (7/10) described changing surgical procedure based on their intraoperative assessment of bone quality. There was consensus on the superiority of cemented femoral fixation in osteoporosis, and the importance of assessing X-rays preoperatively, though attitudes differed on acetabular fixation method, the utility of radiographs to measure bone quality, and current surgical guidelines. Conclusions Bone quality has a significant impact on the decision-making of experienced arthroplasty surgeons, though there are significant limitations in current methods of assessing it. The divergence identified amongst surgeons on the utility of X-rays to assess bone quality, and towards surgical guidelines merit further investigation.