Abstract Background Total hip and knee arthroplasties are among the most commonly performed and resource-intensive orthopaedic procedures in Europe. While national procurement frameworks and registries aim to support evidence-based, cost-effective prosthesis use, little is known about how surgeons make implant selection decisions in practice. This study aimed to identify the factors influencing prosthesis choice among Irish orthopaedic surgeons and to explore variation by grade, region, and hospital sector. Methods A national cross-sectional survey was distributed to orthopaedic surgeons in Ireland. The questionnaire was adapted from a previously validated Australian study and included items on implant autonomy, cost awareness, decision-making factors, registry use, and demographic data. Descriptive and comparative statistics were used to analyse responses. Results Eighty-three surgeons participated, including 61 consultants (73%). Implant quality (6.1), familiarity (5.98), and revision rate (5.53) were ranked as the most influential factors. Consultants reported significantly greater autonomy over implant selection than registrars, particularly in the private sector. Cost was rarely rated as a primary factor, despite most consultants reporting at least approximate cost awareness. Engagement with registry data varied, with consultants more likely to access and prioritise registry outcomes than trainees. Wide variation was observed in implant selection practices, and most registrars reported limited involvement in decision-making. Conclusions Surgeons prioritise implant performance and familiarity. Autonomy and cost awareness vary considerably across grades. These findings suggest opportunities to standardise practice, enhance trainee involvement, and define thresholds for unwarranted variation in implant use. Findings may inform procurement and training strategies to support value-based arthroplasty care in Ireland.
Farrell et al. (Sun,) studied this question.