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Outcome of Hip Arthroscopy: Results of The Learning Curve

Background

Femoroacetabular impingement (FAI) may be a predisposing factor in progression of osteoarthritis. The use of hip arthroscopy is growing in popularity, with increasing uptake by more orthopaedic surgeons with varying degrees of experience. This prospective study examines the learning curve of an arthroscopist setting up his practice.

Methods

Over a twenty month period all patients undergoing hip arthroscopy for femoroacetabular impingement were recorded on a prospective database. Patients were scored pre-operatively and postoperatively at 6 months, 1 and 2 years using the non-arthritic hip score. Need for revision and total hip arthroplasty (THR) were recorded. Data analysed using Wilcoxon’s signed ranks test and ANOVA

Aims of Study

  • Prospectively review the outcome of hip arthroscopy for FAI
  • Explore the learning curve and its effect on clinical outcomes

Results

Intra-articular Pathology

Pie
  • 120 patients, median age 39 years
  • Average follow-up (F/U) 23 months.
  • Median pre-operative score 58
  • Overall median improvement in scores for all patients
    • 6 months: 16 (CI 12 to 20, p<0.05) n= 102
    • 12 months: 9 (CI 3 to 16, p<0.05) n= 63
    • 24 months: 11 (CI 1 to 21, p<0.05) n= 25
  • 12 progressed to THR (mean 49 weeks), 7 revision arthroscopies

Complications

  • 7 minor scuffs to the femoral chondral surface on joint entry
  • 3 transient parasthesia
  • 1 patient with labial groin bruising.

“Learning Curve”. 3 chronological periods of 40 consecutive patients. Results for THR, revision arthroscopy and median improvement of score.

  THR Revision
Arthroscopy
Median
Improvement
(6 months)
95% CI p value F/U (weeks)
Period 1 22.5% 7.5% 16 7 to 23 <0.05 127
Period 2 5% 10% 10 3 to 18 <0.05 96
Period 3 2.5% 0 22 15 to 27 <0.0001 54
p (ANOVA) <0.05 <0.05 <0.05      

Cumulative % of Satisfactory Outcome: Measured as an improvement of 10 points or more on Non-arthritic Hip Score at 6 months.

After “settling in period” the % cumulative satisfaction increases from 41% around the 17th procedure to 64% by the 90th procedure

Graph2

Conclusions

  • Patients see a gradual and significant improvement post hip arthroscopy, with symptoms continuing to improve until 2 years
  • This is a well-tolerated procedure with a low complication rate and the opportunity for treatment of a range of hip pathology
  • A learning curve exists, but a significant improvement in patient outcome is seen after the 70th procedure
  • The number of revision procedures significantly reduces as the learning curve is climbed
  • The need for conversion to THR is significantly reduced, probably due to improved patient selection due to improved clinical experience

Download original document Hip_Arthroscopy_Poster_BHS[1].pdf

 

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