Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Prospective Analysis of the Relationship Between Surgeon Experience and Patient Outcomes

Abstract

Background:Hip arthroscopic surgery is a rapidly growing procedure, but it may be associated with a steep learning curve. Few studies have used patient-reported outcome (PRO) surveys to investigate the relationship between surgeon experience and patient outcomes after the arthroscopic treatment of femoroacetabular impingement (FAI).Hypothesis:Patients undergoing hip arthroscopic surgery for the treatment of FAI in the early stages of a surgeon’s career will have significantly worse outcomes and longer procedure times compared with patients treated after the surgeon has gained experience.Study Design:Cohort study; Level of evidence, 2.Methods:Patients undergoing hip arthroscopic surgery for FAI and labral injuries were prospectively enrolled during a sports medicine fellowship–trained surgeon’s first 15 months of practice. Patients were stratified into an early group, consisting of the first 30 consecutive cases performed by the surgeon, and a late group, consisting of the second 30 consecutive cases. Radiographic and physical examinations were performed preoperatively and postoperatively. PRO surveys, including the 12-item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), were administered preoperatively and at a minimum of 1 year postoperatively.Results:There was no difference between the early and late groups for patient age (37.2 ± 11.5 vs 35.3 ± 10.8 years, respectively; P = .489), body mass index (25.6 ± 4.0 vs 25.1 ± 4.5 kg/m2, respectively; P = .615), or sex (P = .465). There was a significantly increased procedure time (119.3 ± 21.0 vs 99.0 ± 28.6 minutes, respectively; P = .002) and traction time (72.7 ± 21.4 vs 59.0 ± 16.7 minutes, respectively; P = .007) in the early group compared with the late group. Mean postoperative PRO scores significantly improved in both groups compared with preoperative values for all surveys except for the SF-12 mental component summary. No differences were found in PRO score improvements or complication rates between the early and late groups.Conclusion:The total procedure time and traction time decrease after a surgeon’s first 30 hip arthroscopic surgery cases for FAI and labral tears, but patient outcomes can similarly improve regardless of surgeon experience in the early part of his or her career.

The Learning Curve for Hip Arthroscopic Surgery: A Prospective Evaluation With 2-Year Outcomes in Patients With Femoroacetabular Impingement

“…Another previous study found decreasing procedure and traction times after a surgeon’s first 30 cases. 11 However, the current study found that procedure and traction time decreased in a logarithmic curve, reaching a plateau after 70 and 110 cases, respectively. The procedure time plateaued before traction time, which indicates that efficiency in joint access and intra-articular labral repair needed for traction time proficiency takes longer to master compared with other aspects of the case that factor into the procedure time including patient setup, which can be time-consuming for hip arthroscopic surgery.…”

“…These results were using 1-year outcomes and a small cohort size. 11 These findings are in contrast to a prospective study of a single surgeon’s first 100 hip arthroscopic procedures by Konan et al, 16 which showed the highest patient satisfaction and improvement in postoperative Non-Arthritic Hip Score values in the past 30 patients compared with the first 30. The authors also noted a 40% decrease in operative time after the first 30 cases, leading them to quantify a learning curve of 30 cases.…”

“… 16 Conversely, another prospective analysis found no difference in complication rates between a single surgeon’s initial 30 cases and subsequent 30 cases. 11 Further, a retrospective review of 194 patients over the course of 2 years found no change in the incidence of complications with time or number of cases, although the nature of the complications changed with time. 26 Overall complication rates for hip arthroscopic surgery remain low; Clarke et al 7 reported a 1.4% complication rate in a prospective study of 1054 patients undergoing hip arthroscopic surgery.…”

Health-Related Quality of Life After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

“…34 The median MINORS score for the noncomparative studies in this review was 7 (range, 5-9). The median MINORS score for the comparative studies in this review was 12 (range, [10][11][12][13][14][15][16][17][18][19]. Overall, all studies had a clearly stated aim, 82.1% had appropriate endpoints, 67.9% had an appropriate follow-up period, and 75% had loss of follow-up less than 5%.…”

“…10,28,36 Three studies found significant improvement only in specific cohorts or in 1 subset of the SF-12 score. 15,27,29 The remaining 3 studies did not report significance values for postoperative SF-12 score improvement. 4,49,52 Of the 3 studies that found significant improvement in all cohorts, 1 was at follow-up between 12 and 24 months postoperatively, 10 1 between 25 months and 5 years, 28 and the last at greater than 5 years.…”