Purpose
The learning curve for hip arthroscopy is consistently characterized as “steep.” The
purpose of this systematic review was to (1) identify the various learning curves
reported in the literature, (2) examine the evidence supporting these curves, and
(3) determine whether this evidence supports an accepted number of cases needed to
achieve proficiency.
Methods
The electronic databases Embase and Medline were screened for any clinical studies
reporting learning curves in hip arthroscopy. Two reviewers conducted a full-text
review of eligible studies and a hand search of conference proceedings and reference
sections of the included articles. Inclusion/exclusion criteria were applied, and
a quality assessment was completed for each included article. Descriptive statistics
were compiled.
Results
We identified 6 studies with a total of 1,063 patients. Studies grouped surgical cases
into “early” versus “late” in a surgeon's experience, with 30 cases being the most
common cutoff used. Most of these studies used descriptive statistics and operative
time and complication rates as measures of competence. Five of 6 studies showed improvement
in these measures between early and late experience, but only one study proposed a
bona fide curve.
Conclusions
This review shows that when 30 cases was used as the cutoff point to differentiate
between early and late cases in a surgeon's experience, there were significant reductions
in operative time and complication rates. However, there was insufficient evidence
to quantify the learning curve and validate 30, or any number of cases, as the point
at which the learning curve plateaus. As a result, this number should be interpreted
with caution.
Level of Evidence
Level IV, systematic review of Level IV studies.
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Article info
Publication history
Published online: January 24, 2014
Accepted:
November 12,
2013
Received:
October 28,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: M.B. has received support from Smith and Nephew, Stryker, Amgen, Zimmer, Moximed, DePuy, Eli Lily, and Bioventus.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
