Skip to main content
SpringerLink
Log in

Complications in hip arthroscopy: necessity of supervision during the learning curve

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to determine whether the learning curve of arthroscopic treatment of femoroacetabular impingement (FAI) could be verified by analyzing the complication rate of this procedure. Additionally, it was investigated whether supervision by an experienced surgeon leads to a steeper learning curve (lower number of complications) when starting to perform arthroscopic FAI treatment.

Methods

The complications occurring in 317 consecutive patients treated with the sole diagnosis of FAI were analyzed. 256 patients (collective A) were treated by surgeon A between June 2005 and January 2010. Sixty-one patients (collective B) were treated by surgeon B between August 2008 and December 2009. From January to June 2008, surgeon B performed many hip arthroscopies under supervision of surgeon A. Complications were recorded in a central complication register. Statistic analysis of the complication rates was performed using Fischer’s exact T test.

Results

Subdividing collective A chronologically into thirds a significant decline of complications (p = 0.0044) was found with growing experience of the surgeon. Comparing the first 61 patients of both surgeons a significantly lower complication rate was discovered in the patients of surgeon B (p = 0.0375). In total there were 21 complications (6.6 %; CI 4.4–9.9 %). The observed complication rate was 7.0 % in collective A and 4.9 % in collective B.

Conclusion

The learning curve can be comprehended by the distribution of complications in collective A. Having spent 6 months performing under supervision of surgeon A, surgeon B has a lower complication rate than surgeon A when comparing the first 61 patients each surgeon operated on. This implies that surgeon B benefits from the experience of surgeon A. According to this analysis, beginners in arthroscopic FAI treatment should be taught at a specialized centre to reduce the number of complications.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87(7):1012–1018

    Article  CAS  PubMed  Google Scholar 

  2. Bedi A, Kelly BT, Khanduja V (2013) Arthroscopic hip preservation surgery: current concepts and perspective. Bone Joint J 95-B(1):10–19

    Article  CAS  PubMed  Google Scholar 

  3. Botser IB, Smith TW Jr, Nasser R, Domb BG (2011) Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 27(2):270–278

    Article  PubMed  Google Scholar 

  4. Bredella MA, Ulbrich EJ, Stoller DW, Anderson SE (2013) Femoroacetabular impingement. Magn Reson Imaging Clin N Am 21(1):45–64

    Article  PubMed  Google Scholar 

  5. Buchler L, Neumann M, Schwab JM, Iselin L, Tannast M, Beck M (2013) Arthroscopic versus open cam resection in the treatment of femoroacetabular impingement. Arthroscopy 29(4):653–660

    Article  PubMed  Google Scholar 

  6. Byrd T (2001) Hip arthroscopy. The supine position. Clin Sports Med 20(4):703–731

    Article  CAS  PubMed  Google Scholar 

  7. Byrd T (2006) Hip arthroscopy: surgical indications. Arthroscopy 22(12):1260–1262

    Article  PubMed  Google Scholar 

  8. Byrd T, Jones KS (2009) Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 467(3):739–746

    Article  PubMed Central  PubMed  Google Scholar 

  9. Byrd T, Jones KS (2009) Arthroscopic management of femoroacetabular impingement. Instr Course Lect 58:231–239

    PubMed  Google Scholar 

  10. Clarke MT, Arora A, Villar RN (2003) Hip arthroscopy: complications in 1,054 cases. Clin Orthop Relat Res 406:84–88

    Article  PubMed  Google Scholar 

  11. Clohisy JC, St John LC, Schutz AL (2010) Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res 468(2):555–564

    Article  PubMed Central  PubMed  Google Scholar 

  12. Colvin AC, Harrast J, Harner C (2012) Trends in hip arthroscopy. J Bone Joint Surg Am 94(4):e23

    Article  PubMed  Google Scholar 

  13. Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M (2007) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.1):36–53

    PubMed  Google Scholar 

  14. Fayad TE, Khan MA, Haddad FS (2013) Femoroacetabular impingement: an arthroscopic solution. Bone Joint J 95-B(11 Suppl A):26–30

    Article  CAS  PubMed  Google Scholar 

  15. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    PubMed  Google Scholar 

  16. Harris JD, McCormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR Jr, Bush-Joseph CA, Nho SJ (2013) Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy 29(3):589–595

    Article  PubMed  Google Scholar 

  17. Ilizaliturri VM Jr (2009) Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res 467(3):760–768

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83(2):171–176

    Article  CAS  PubMed  Google Scholar 

  19. 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):52–56

    Article  PubMed  Google Scholar 

  20. Kowalczuk M, Bhandari M, Farrokhyar F, Wong I, Chahal M, Neely S, Gandhi R, Ayeni OR (2012) Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(7):1669–1675

    Article  PubMed  Google Scholar 

  21. Larson CM, Giveans MR, Taylor M (2011) Does arthroscopic FAI correction improve function with radiographic arthritis? Clin Orthop Relat Res 469(6):1667–1676

    Article  PubMed Central  PubMed  Google Scholar 

  22. Lee YK, Ha YC, Hwang DS, Koo KH (2012) Learning curve of basic hip arthroscopy technique: CUSUM analysis. Knee Surg Sports Traumatol Arthrosc 21(8):1940–1944

    Article  PubMed  Google Scholar 

  23. Leunig M, Beaule PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 467(3):616–622

    Article  PubMed Central  PubMed  Google Scholar 

  24. Mohtadi NG, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N, Sekiya JK, Kelly BT, Werle JR, Leunig M, McCarthy JC, Martin HD, Byrd JW, Philippon MJ, Martin RL, Guanche CA, Clohisy JC, Sampson TG, Kocher MS, Larson CM, Multicenter Arthroscopy of the Hip Outcomes Research N (2012) The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy 28(5):595–605

    Article  PubMed  Google Scholar 

  25. Ng VY, Arora N, Best TM, Pan X, Ellis TJ (2010) Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med 38(11):2337–2345

    Article  PubMed  Google Scholar 

  26. Sampson TG (2006) Arthroscopic treatment of femoroacetabular impingement: a proposed technique with clinical experience. Instr Course Lect 55:337–346

    PubMed  Google Scholar 

  27. Tran P, Pritchard M, O’Donnell J (2012) Outcome of arthroscopic treatment for cam type femoroacetabular impingement in adolescents. ANZ J Surg 83(5):382–386

    Article  PubMed  Google Scholar 

  28. Zingg PO, Ulbrich EJ, Buehler TC, Kalberer F, Poutawera VR, Dora C (2013) Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results. Arch Orthop Trauma Surg 133(1):69–79

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Germany

    Florian Dietrich, Claus Eiermann & Wolfgang Miehlke

  2. Department of Trauma and Orthopaedic Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Christian Ries

  3. Orthopaedie Kurpfalz, Hasenackerstr. 13-17, 68163, Mannheim, Germany

    Christian Sobau

Authors
  1. Florian Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Ries
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claus Eiermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Miehlke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Sobau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Dietrich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dietrich, F., Ries, C., Eiermann, C. et al. Complications in hip arthroscopy: necessity of supervision during the learning curve. Knee Surg Sports Traumatol Arthrosc 22, 953–958 (2014). https://doi.org/10.1007/s00167-014-2893-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2893-9

Keywords

Search

Navigation