What question did this study set out to answer?

The study aims to develop a discrete choice experiment design to understand how patient characteristics affect surgeons' choices in total hip replacement.

July 17, 2026Open Access

Development of a discrete choice experiment design to explore how patient characteristics influence preferred fixation method in total hip replacement in the UK

PBPetra BajiUniversity of Bristol CPCecily PalmerUniversity of Bristol AMAndrew MooreUniversity of Bristol

Key Points

The study aims to develop a discrete choice experiment design to understand how patient characteristics affect surgeons' choices in total hip replacement.
Developed attributes and levels from literature review and expert panel input.
Created a D-efficient experimental design for patient profiles.
Conducted cognitive debriefing and pre-testing with surgeons to ensure survey feasibility.
Identified patient profiles based on age, sex, medical condition, activity level, and fracture risk.
Generated 40 patient profiles divided into 4 blocks for randomized respondent distribution.
Confirmed survey feasibility through cognitive debriefing with surgeons.

Abstract

Abstract Background Currently it is unclear how patient characteristics influence orthopaedic surgeons’ decision-making in choice of implant and fixation. The aim of this study was to develop a discrete choice experiment (DCE) design to explore how patient characteristics influence surgeons’ choices of implant fixation in total hip replacement (THR) in a national survey in the UK. Methods We followed a three-stage process to develop the DCE design. In stage 1, we used evidence from a literature review, expert panel of five surgeons, and Think-Aloud interviews with two surgeons to develop attributes and levels to describe patient profiles. In the stage 2, we developed a D-efficient experimental design for the survey. In stage 3, we pre-tested the survey using cognitive de-briefing with three surgeons and piloted the survey with ten surgeons. Results Final attributes and levels were: age (55,65,75,85 years), sex (female, male), medical condition measured by ASA grade and BMI (3 levels: ASA III and BMI is ≥ 40; ASA III and BMI <40; ASA I or II and BMI < 40), patients’ expected physical activity level after the surgery including sports, everyday activities and employment (mostly inactive, moderately active, very active), and surgeons’ perception of the risk of periprosthetic fracture (high risk: yes, no). We generated an efficient experimental design with 40 patient profiles divided into 4 blocks of 10 profiles to be randomly distributed across respondents. Pre-test of the survey with cognitive debriefing confirmed the feasibility of the DCE task. Conclusion We co-developed a DCE design with orthopaedic surgeons to explore how patient characteristics influence THR fixation methods in a survey among UK orthopaedic surgeons. Results of the DCE will inform 1) the design of a large randomised controlled trial (HIPPY) that aims to find out which hip implant fixation (cemented, uncemented, or hybrid) is the most effective and cost-effective for patients aged under 70 years, undergoing primary elective THR and 2) the implementation strategy of trial findings into clinical practice.

Ask AI

Helpful

Bookmark

View Full Paper