International Orthopaedics

, Volume 42, Issue 4, pp 777–782 | Cite as

Hip arthroscopy learning curve: a prospective single-surgeon study

  • Jakub Kautzner
  • Petr Zeman
  • Andrej Stančák
  • Vojtěch Havlas
Original Paper



Arthroscopy of the hip joint is considered a demanding procedure with long learning curve. There are only a few studies that concentrate on this topic. This prospective clinical study evaluates the learning curve of the hip arthroscopy based on clinical outcomes, surgical time, and complication rate.


In this study, we first evaluated 150 hip arthroscopy procedures performed by a single surgeon. The patient group consisted of 86 females and 64 males with mean age 37 years (range 16–69). Study cohorts were divided into groups of 50 patients. Surgical time, complication rate and clinical results based on NAHS score were recorded for each group. Statistical analysis of differences between groups was performed using the ANOVA method and paired t-test.


We found a statistically significant decrease of complication rate with more procedures performed. There were significantly better clinical outcomes after at least 100 procedures. No difference in surgical time was found, but towards the end of the learning curve, more complex procedures were performed. The only statistical difference was the portal setup time. The learning curves were constructed based on these results.


Hip arthroscopy provides very good clinical outcomes if precisely indicated and performed. It is, however, a demanding procedure with many possible pitfalls and complications. According to our study, at least 100 procedures are needed to gain basic technical and indication skills. The presence of a more skilled surgeon in the beginning of the learning curve is advised to reduce the complication rate.


Hip arthroscopy Femoro-acetabular impingement Hip reconstructive surgery Learning curve 


Compliance with ethical standards

Conflict of interest

The authors state that this study was in compliance with regional ethical standards and laws. This study was supported by a grant from the Ministry of Health, Czech Republic - conceptual development of research organisation, Motol Univesity Hospital, Prague, Czech Republic No.00064203. On behalf of all authors, the corresponding author states that there are no other conflicts of interest.


  1. 1.
    de Amorim Cabrita HA, de Castro Trindade CA, de Campos Gurgel HM, Leal RD, de Souza Marques Rda F (2014) Hip arthroscopy. Rev Bras Ortop 50(3):245–253CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hoppe DJ, de Sa D, Simunovic N, Bhandari M, Safran MR, Larson CM, Ayeni OR (2014) The learning curve for hip arthroscopy: a systematic review. Arthroscopy 30(3):389–397CrossRefPubMedGoogle Scholar
  3. 3.
    Boden RA, Wall AP, Fehily MJ (2014) Results of the learning curve for interventional hip arthroscopy: a prospective study. Acta Orthop Belg 80(1):39–44PubMedGoogle Scholar
  4. 4.
    Konan S, Rhee SJ, Haddad FS (2011) Hip arthroscopy: analysis of a single surgeon’s learning experience. J Bone Joint Surg Am 93(Suppl 2):52–56CrossRefPubMedGoogle Scholar
  5. 5.
    Lee YK, Ha YC, Hwang DS, Koo KH (2013) Learning curve of basic hip arthroscopy technique: CUSUM analysis. Knee Surg Sports Traumatol Arthrosc 21(8):1940–1944CrossRefPubMedGoogle Scholar
  6. 6.
    Hodgins JL, Veillette C, Biau D, Sonnadara R (2014) The knee arthroscopy learning curve: quantitative assessment of surgical skills. Arthroscopy 30(5):613–621CrossRefPubMedGoogle Scholar
  7. 7.
    Howells NR, Auplish S, Hand GC, Gill HS, Carr AJ, Rees JL (2009) Retention of arthroscopic shoulder skills learned with use of a simulator. Demonstration of a learning curve and loss of performance level after a time delay. J Bone Joint Surg Am 91(5):1207–1213CrossRefPubMedGoogle Scholar
  8. 8.
    Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC (2003) The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res 406:75–83CrossRefGoogle Scholar
  9. 9.
    Gupta A, Redmond JM, Hammarstedt JE, Schwindel L, Domb BG (2014) Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence. Arthroscopy 30(10):1342–1348CrossRefPubMedGoogle Scholar
  10. 10.
    Park MS, Yoon SJ, Kim YJ, Chung WC (2014) Hip arthroscopy for femoroacetabular impingement: the changing nature and severity of associated complications over time. Arthroscopy 30(8):957–963CrossRefPubMedGoogle Scholar
  11. 11.
    Oak N, Mendez-Zfass M, Lesniak BP, Larson CM, Kelly BT, Bedi A (2013) Complications in hip arthroscopy. Sports Med Arthrosc 21(2):97–105CrossRefPubMedGoogle Scholar
  12. 12.
    Dietrich F, Ries C, Eiermann C, Miehlke W, Sobau C (2014) Complications in hip arthroscopy: necessity of supervision during the learning curve. Knee Surg Sports Traumatol Arthrosc 22(4):953–958CrossRefPubMedGoogle Scholar
  13. 13.
    Burrus MT, Cowan JB, Bedi A (2016) Avoiding failure in hip arthroscopy: complications, pearls, and pitfalls. Clin Sports Med 35(3):487–501CrossRefPubMedGoogle Scholar
  14. 14.
    Fayad TE, Khan MA, Haddad FS (2013) Femoroacetabular impingement: an arthroscopic solution. Bone Joint J 95-B:26–30CrossRefPubMedGoogle Scholar
  15. 15.
    Bedi A, Zaltz I, De La Torre K, Kelly BT (2011) Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med 39(Suppl):20S–28SCrossRefPubMedGoogle Scholar
  16. 16.
    Byrd JW (2017) Editorial commentary: hip femoroacetabular impingement correction: risk versus reward, or how much is too much? Arthroscopy 33(4):780–782CrossRefPubMedGoogle Scholar
  17. 17.
    Souza BG, Dani WS, Honda EK, Ricioli W Jr, Guimarães RP, Ono NK, Polesello GC (2010) Do complications in hip arthroscopy change with experience? Arthroscopy 26:1053–1057CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Jakub Kautzner
    • 1
  • Petr Zeman
    • 2
  • Andrej Stančák
    • 1
  • Vojtěch Havlas
    • 1
  1. 1.Department of Orthopaedics and Traumatology, 2nd Faculty of Medicine, Motol Hospital PragueCharles UniversityPragueCzech Republic
  2. 2.Department of Orthopaedics and Traumatology, Medical Faculty PilsenCharles UniversityPilsenCzech Republic

Personalised recommendations