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Scientific Articles   |    
Hip Arthroscopy: Analysis of a Single Surgeon's Learning Experience
Sujith Konan, MRCS1; Shin-Jae Rhee, MRCS1; Fares S. Haddad, MCh(Orth), FRCS(Tr&Orth)1
1 Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, England. E-mail address for S. Konan: docsujith@yahoo.co.uk
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Smith & Nephew, UK; and Stryker).

Investigation performed at the Department of Trauma and Orthopaedics, University College London Hospital, London, England

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):52-56. doi: 10.2106/JBJS.J.01587
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Abstract

Background: 

The aim of this study was to objectively quantify a surgeon's learning experience for hip arthroscopy.

Methods: 

We prospectively reviewed the first 100 hip arthroscopic procedures performed between 1999 and 2004 by a single experienced consultant orthopaedic surgeon. In the second part of the study, three groups of patients were sequentially analyzed: Group 1 included the first thirty patients treated by the surgeon; group 2, the sixty-first through ninetieth patients; and group 3, the 121st through 150th patients. The groups were compared with regard to the diagnosis, the duration of the central and peripheral compartment procedure, patient satisfaction, conversion to arthroplasty, and the nonarthritic hip score.

Results: 

There was a decrease in complications from the first thirty cases to the remaining seventy operations. There was an overall decrease in operative time over the 100 cases, representing a gradual learning process. A marked decrease in the operative time for central compartment arthroscopy was noted when we compared group 1 (mean, seventy minutes; range, forty-five to ninety-eight minutes), group 2 (mean, forty-eight minutes; range, twenty-six to fifty-nine minutes), and group 3 (mean, thirty-seven minutes; range, eighteen to sixty-one minutes). The operative time for peripheral compartment arthroscopy also decreased from group 2 (mean, ninety-one minutes; range, sixty to 126 minutes) to group 3 (mean, forty-five minutes; range, thirty-six to sixty-two minutes). There was an overall decrease in operative time over the first 100 cases. No difference among groups was noted in the number of cases requiring a reoperation or conversion to arthroplasty. There was a higher complication rate in the first thirty cases. An increase in the nonarthritic hip scores was noted postoperatively in the two groups in which the preoperative score had been measured. The postoperative score improved from group 1 (mean, 69; range, 39 to 84) to group 2 (mean, 79; range, 58 to 92) to group 3 (mean, 86; range, 51 to 98). Patient satisfaction was highest in group 3.

Conclusions: 

Hip arthroscopy is associated with high patient satisfaction and good short-term outcomes, but there is a learning curve that we estimate to be approximately thirty cases.

Level of Evidence: 

Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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