REC REF:  20/LO/0432

Active and recruiting

Although the majority of Total Hip Arthroplasty (THA) procedures in the United Kingdom are performed through an open surgical posterior approach (PA), strong evidence now exists which indicates the direct anterior approach (DAA) is safer and less invasive.
In this study, we are using Observational Clinical Human Reliability Analysis (OCHRA) to help us understand error and variation in clinical practice, allowing us to standardise techniques and apply them through virtual reality (VR) simulation. This has the potential to lower the early complication rate and may mitigate the deleterious effects of the low-volume THA surgeon.


The primary objective of the study is to apply a human factors approach using Observational Clinical Human Reliability Analysis (OCHRA) and to evaluate variation in practice performing total hip arthroplasty surgery through two approaches (Direct Anterior Approach (DAA) & Posterior Approache (PA).

The secondary objective is to evaluate whether surgeons trained using the VR simulator can perform DAA and PA THA as effectively as surgeons trained using conventional peri-operative training, as assessed by their performance on a cadaveric pelvis.


Methods of analysing performance in clinical practice include retrospective audits, prospective research studies, and reviews of national joint registry data on implant survival. While each of these methods offers valuable information related to clinical outcome, none offer detailed insight into what surgical technical and non-technical factors can impact performance. Instead, this requires an analysis of the mechanisms underlying successful and unsuccessful surgery to identify procedural steps. Education that optimises human factors and decision-making and utilises validated simulators may deliver training to both juniors and experts in a safe and effective manner.
The aim of this study is to establish an agreed protocol by filming expert surgeons perform DAA and PA THA, which leads to establishing a filming protocol for the OCHRA videos.