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The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists

  • Symposium: Papers Presented at the Hip Society Meetings 2009
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Patient demand and surgeon interest in hip resurfacing has recently increased, but surgeons in the United States are relatively inexperienced with this procedure. We determined the learning curve associated with hip resurfacing and compared the rate of early complications of the first 650 hip resurfacings between five experienced hip surgeons and a national safety survey database study we previously published, which included 89 surgeons and 537 hip resurfacings. Patient demographics and adverse events were recorded. Specific features on pre- and postoperative radiographs were measured in a blinded fashion by a single observer. There were 13 major complications (2.0%), which is 3.7 times lower than our national safety survey complication rate of 7.4%. All fractures occurred in the first 25 cases performed. The complication rate was higher for the first 25 procedures (5.6%) compared with the second 25 procedures (1.6%). For experienced hip surgeons, the learning curve for avoiding early complications was short, 25 cases or less. The learning curve for achieving the desired component positioning radiographically was much longer, 75 to 100 cases or more. If achieving some ideal component position proves important for long-term function and implant survival, improved instrumentation and surgical techniques would be necessary to shorten the learning curve.

Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Jean (Qin) Zhang, Division of Biostatistics at Washington University School of Medicine, for her help with the statistical analyses.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University, St Louis, MO, 63130, USA

    Ryan M. Nunley MD, Jinjun Zhu MD, PhD & Robert L. Barrack MD

  2. Department of Orthopedic Surgery, Cleveland Clinic Euclid Hospital, Cleveland, OH, USA

    Peter J. Brooks MD

  3. Anderson Orthopaedic Research Institute, Alexandria, VA, USA

    C. Anderson Engh Jr. MD

  4. Florida Medical Clinic, Tampa, FL, USA

    Stephen J. Raterman MD

  5. Private Practice, Madison, WI, USA

    John S. Rogerson MD

Authors
  1. Ryan M. Nunley MD
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  2. Jinjun Zhu MD, PhD
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  3. Peter J. Brooks MD
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  4. C. Anderson Engh Jr. MD
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  5. Stephen J. Raterman MD
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  6. John S. Rogerson MD
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  7. Robert L. Barrack MD
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Corresponding author

Correspondence to Ryan M. Nunley MD.

Additional information

One of the authors (RMN) has received institutional research support from Smith & Nephew (Memphis, TN). One of the authors (PJB) is a consultant for Stryker Orthopaedics (Mahwah, NJ) and Smith & Nephew. One of the authors (CAE) is a consultant for LifeNet (Virginia Beach, VA), Smith & Nephew, and DePuy Orthopaedics (Warsaw, IN) and receives institutional support from Inova Health System (Fairfax, VA). One of the authors (SJR) is a consultant for Smith & Nephew. One of the authors (JSR) is a consultant for Smith & Nephew but has received no remuneration. One of the authors (RLB) is a designer (royalty income) for Smith & Nephew and receives institutional research support from Smith & Nephew.

Washington University institutional review board approved the protocol for this investigation and all investigations were conducted in conformity with ethical principles of research.

This work was performed at Washington University, St Louis, MO, USA.

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Nunley, R.M., Zhu, J., Brooks, P.J. et al. The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists. Clin Orthop Relat Res 468, 382–391 (2010). https://doi.org/10.1007/s11999-009-1106-1

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  • DOI: https://doi.org/10.1007/s11999-009-1106-1

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