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

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.