Current Trends and Variability in Preoperative Planning for Total Hip Arthroplasty: A Nationwide Survey of Orthopaedic Surgeons in Spain

Background Preoperative evaluation plays a crucial role in total hip arthroplasty (THA), guiding implant selection and surgical planning. Factors such as patient age, body mass index (BMI), and proximal femoral morphology (Dorr classification) are routinely considered, while bone mineral density (BMD) assessment through dual-energy X-ray absorptiometry (DXA) and 3D-DXA remains underutilised. Limited data exist on real-world variability in preoperative planning practices among orthopaedic surgeons. Methods A cross-sectional online survey was conducted among members of the Spanish Hip Surgery Association (SECCA). The questionnaire included demographic data, preoperative planning practices, and implant choices based on four clinical case scenarios with incremental imaging information (X-ray, DXA, 3D-DXA). Responses were analysed using descriptive statistics and chi-square tests to explore associations with surgeon demographics and implant decisions. Results A total of 102 orthopaedic surgeons (45% response rate) completed the survey. Most respondents had > 10 years of surgical experience (89%) and performed > 50 THAs annually (71%). Preoperative planning relied predominantly on pelvic X-rays (100%), patient age (96%), and Dorr classification (76%). Digital templating (31%), DXA (15%), and 3D-DXA (2%) were infrequently used. Younger and less experienced surgeons more frequently selected Dorr types A and C (p < 0.05). Implant selection was significantly influenced by Dorr type (p < 0.05) and by BMD values (p < 0.05), whereas 3D-DXA had a limited impact on decision-making. Conclusions Preoperative planning for THA demonstrates variability among Spanish orthopaedic surgeons. While patient age and femoral morphology remain central to implant selection, the systematic assessment of BMD is rarely incorporated despite its clinical relevance. These findings underscore the need for standardized protocols and broader integration of digital planning and bone quality assessment into routine THA practice.