title: Surgical approach and prosthesis fixation in hip arthroplasty world wide.
abstract: BACKGROUND
  Hip arthroplasty is one of the most common and successful surgical procedures worldwide. Component design and materials as well as surgical techniques constantly evolve. There is no consensus among surgeons regarding the ideal surgical approach and method of fixation.
  
  
  METHODS
  292 orthopedic surgeons of 10 subspecialties from 57 countries were surveyed on their choice of surgical approach and prosthesis fixation in hip arthroplasty. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications.
  
  
  RESULTS
  The response rate was 95-98 %. Surgeons were split between the posterior approach (45 %) and the direct lateral approach (42 %) followed by the anterior approach (10 %) or other (3 %). North American surgeons favored the posterior approach more often than Europeans (69 % compared to 36 %, P < 0.0001) and surgeons from other countries (69 % compared to 45 %, P = 0.01). Sixty-eight percent of all surgeons routinely used noncemented hip prosthesis while 16 % use cemented and 16 % hybrid fixation. Noncemented fixation was preferred among surgeons from Europe and North America compared to other countries (73 % compared to 55 %, P < 0.05). There were no significant differences based on subspecialty, seniority or the number of years of experience.
  
  
  CONCLUSIONS
  The most common surgical approaches in use in hip arthroplasty are posterior and lateral. Anterior approach is used by a minority of orthopedic surgeons for that purpose. Cementing hip prosthesis is falling out of favor among orthopedic surgeons worldwide. The trend toward un-cemented hip arthroplasty is not well supported in the current literature.
authors.affiliation: Department of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 64239, Israel, ofirchik@yahoo.com.
authors.forename: Ofir
authors.initials: O
authors.lastname: Chechik
authors.forename: Morsi
authors.initials: M
authors.lastname: Khashan
authors.forename: Ran
authors.initials: R
authors.lastname: Lador
authors.forename: Moshe
authors.initials: M
authors.lastname: Salai
authors.forename: Eyal
authors.initials: E
authors.lastname: Amar
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements; D006801:Humans; D038622:Internationality; D009985:Orthopedics; D010818:Practice Patterns, Physicians'; D060489:Prosthesis Retention; D011795:Surveys and Questionnaires
chemical_list: D001843:Bone Cements