Flores Sergio E, Borak Kristina R, Zhang Alan L
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
Orthop J Sports Med. 2018 Feb 14;6(2):2325967118755048. doi: 10.1177/2325967118755048. eCollection 2018 Feb.
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).
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.
Cohort study; Level of evidence, 2.
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.
There was no difference between the early and late groups for patient age (37.2 ± 11.5 vs 35.3 ± 10.8 years, respectively; = .489), body mass index (25.6 ± 4.0 vs 25.1 ± 4.5 kg/m, respectively; = .615), or sex ( = .465). There was a significantly increased procedure time (119.3 ± 21.0 vs 99.0 ± 28.6 minutes, respectively; = .002) and traction time (72.7 ± 21.4 vs 59.0 ± 16.7 minutes, respectively; = .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.
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.
髋关节镜手术是一种迅速发展的手术，但可能与陡峭的学习曲线相关。很少有研究使用患者报告结局（PRO）调查来研究髋关节镜治疗股骨髋臼撞击症（FAI）后外科医生经验与患者结局之间的关系。
与外科医生积累经验后治疗的患者相比，在其职业生涯早期接受髋关节镜手术治疗FAI的患者结局会明显更差，手术时间更长。
队列研究；证据等级，2级。
在一位接受运动医学专科培训的外科医生执业的前15个月中，前瞻性纳入因FAI和盂唇损伤接受髋关节镜手术的患者。患者被分为早期组，由外科医生连续进行的前30例病例组成，以及晚期组，由接下来连续的30例病例组成。术前和术后进行影像学和体格检查。术前以及术后至少1年进行PRO调查问卷，包括12项简短健康调查（SF - 12）、改良Harris髋关节评分（mHHS）以及髋关节功能与骨关节炎结局评分（HOOS）。
早期组和晚期组在患者年龄（分别为37.2±11.5岁和35.3±10.8岁；P = 0.489）、体重指数（分别为25.6±4.0和25.1±4.5 kg/m²；P = 0.615）或性别（P = 0.465）方面无差异。与晚期组相比，早期组的手术时间（分别为119.3±21.0分钟和99.0±28.6分钟；P = 0.002）和牵引时间（分别为72.7±21.4分钟和59.0±16.7分钟；P = 0.007）显著增加。与术前值相比，两组所有调查问卷（除SF - 12心理成分总结外）的术后平均PRO评分均显著改善。早期组和晚期组在PRO评分改善或并发症发生率方面未发现差异。
外科医生在完成前30例FAI和盂唇撕裂的髋关节镜手术后，总手术时间和牵引时间会减少，但无论其职业生涯早期的经验如何，患者结局都能同样得到改善。
