title: Complications in hip arthroscopy: necessity of supervision during the learning curve.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Germany, flo.dietrich@gmx.de.
authors: Florian
authors: F
authors: Dietrich
authors: Christian
authors: C
authors: Ries
authors: Claus
authors: C
authors: Eiermann
authors: Wolfgang
authors: W
authors: Miehlke
authors: Christian
authors: C
authors: Sobau
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects* / Q000193:education*; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult