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The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Research focusing on the complex factors leading to patients decisions to replace their arthritic hip has been limited in favor of quantitative studies focusing on surgery outcomes. The purpose of this study was twofold: (1) to further explore patients experiences and their decision-making processes to undergo total hip arthroplasty and (2) to examine the factors that influenced patients decisions about the type of surgical procedure (approach, implants).

Methods

In 2005, 18 patients who were either scheduled for an upcoming total hip arthroplasty or had completed total hip arthroplasty participated in semi-structured interviews (N = 9) or a focus group (N = 9) regarding their decision to undergo hip arthroplasty. The canons and procedures of the grounded theory approach to qualitative research guided the coding and content analysis of the data derived from the focus group and semi-structured interviews.

Results

Three main categories or core concepts that emerged from the interviews and focus group were labeled (1) limitations, (2) psychological distress, and (3) perceptions about hip arthroplasty. These three categories yielded a total of ten subcategories. The participants in our study had lived with a hip arthritis to a point beyond which all decided to have hip replacement surgery (“the final straw”). Decisions to undergo surgery were based upon an increasing severity of limitations affecting their basic quality of daily living, relationships and psychological well-being. Participants acknowledged that their choice of surgeon, type of procedure and implants were largely based on their desire to choose a technique that minimized disruption to their muscles and led to a quick recovery. Having decided on the type of surgery, participants used colleagues, family, and the internet to identify the most qualified surgeons in their area.

Conclusion

Our study sheds further light on the complex process of patients “final straw” towards a total hip arthroplasty. Surgeons should be aware of patients personal processes in order to optimize their surgical experiences and outcomes. Future research should aim to resolve optimal approaches to arthroplasty in light of patients preferences for muscle-sparing and “minimally invasive” approaches.

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Acknowledgments

We are grateful to those 18 participants who provided considerable insight to our interviews and focus group.

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Corresponding author

Correspondence to Mohit Bhandari.

Additional information

Dr. Bhandari is supported, in part, by a Canada Research Chair, McMaster University. No funding was received in preparation of this manuscript.

Appendices

Appendix 1

The Anterior THA Research Collaborative Members are: Chair: Joel M. Matta MD, Dodgin MD, Mohit Bhandari MD, Gary Bradley MD, Jim Grimes MD, John Masonis MD, Stefan Kreuzer MD, Andrew Yun MD, Gary Matthys MD, Brian Jewett MD, Michael Bellino MD, Charles Clark MD, Brian Jewett MD, Gary Matthys MD, Steve Myers MD Tania Ferguson, David Balderee, MD, Thomas Knutson, Sonny Bal, Stephen Lester MD, Peter Hanson MD, Eric Johnson MD, Tim Lovell MD, Daniel Gannon MD, Robert Schwartz MD, Brian Rosenburg MD, Patrick Kirk MD, Thomas Eagen MD, Lester Littel MD, Phil Kregor MD.

Appendix 2

Summary of canons from the grounded theory approach

1.

Data collection and analysis are interrelated processes

2.

Concepts are basic units of analysis not the actual data per se

3.

Categories must be developed and related

4.

Sampling proceeds on theoretical grounds in terms of concepts, their properties, dimensions and variations

5.

Analysis makes use of constant comparisons

6.

Patterns and variations must be accounted for, that is, the data is examined for regularities and irregularities

7.

Process must be built into the theory by: 1) breaking a phenomenon down into stages, phases or steps 2) noting purposeful actions/interactions

8.

Writing theoretical memos is an integral part of doing grounded theory research

9.

Hypotheses about relationships among categories should be developed and verified as much as possible during the research process

10.

A grounded theorist need not work alone. Discussion with other researchers working on the same topic under study is encouraged

11.

Broader structural conditions such as economic conditions, cultural values, political trends and social movements must be analyzed, however microscopic the research [11]

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Dosanjh, S., Matta, J.M., Bhandari, M. et al. The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty. Arch Orthop Trauma Surg 129, 719–727 (2009). https://doi.org/10.1007/s00402-008-0671-1

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  • DOI: https://doi.org/10.1007/s00402-008-0671-1

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