Paper 07: The True Learning Curve in Hip Arthroscopy According to Patient-Reported Outcomes

OBJECTIVES: Arthroscopic correction of FAI is a powerful way to improve pain and function in athletes and patients. Surgeons learning hip arthroscopy experience a learning curve while gaining competence. The objective of the present study was to evaluate the learning curve in hip arthroscopy for FAI according to improvements in patient-reported outcome instruments. METHODS: A retrospective review was performed of a single surgeon’s first 1000 hip arthroscopy cases during their first 4 years in practice. Arthroscopy cases that occurred concurrently with PAO or femoral osteotomy (n=360) were excluded. Convenience samples (n=50) were taken from each year in practice. Pre-operative and post-operative HOOS- Pain and HOOS-physical function scores were obtained. Linear trends were assessed, and cutoffs for MCID for HOOS (10 points) were surveyed across time. Students t tests were used for continuous variables and chi squared tests were used for categorical variables and significance was set to p<0.05. RESULTS: During the first 250 cases, a sample of patients was obtained (n=50), and 11/50 did not meet MCID (22%) for HOOS Pain at 1-year follow-up. A convenience sample of cases subsequent to this from cases 251-1000 (n=100) 11/100 after that did not meet MCID (11.0%, p<0.05). The mean 1-year postop HOOS Pain score for year 1 was 82.77, year 2 was 90.56, year 3 was 89.34 and year 4 was 93.48 (P<0.05). Delta HOOS Pain of PS did not change over time, p>0.05). For both HOOS Pain and Physical Function subscales, 1-year postop scores continued to improve over the 4-year 1000-case study period (graph). CONCLUSIONS: According to the HOOS validated patient reported outcome instrument, the learning curve for significant benefits in hip arthroscopy is between 130-250 cases. Many patients (almost 80%) saw significant clinical benefit during the learning curve, however the quality of outcome was significantly improved after 250 cases. 1-year post-op PROs appear to continually improve even after cases 750-1000