The Education and Training of Future Hip Preservation Surgeons: The Aggregate Recommendations of High-Volume Surgeons

Transcription

1 The Education and Training of Future Hip Preservation Surgeons: The Aggregate Recommendations of High-Volume Surgeons A Chen 1,2, M Steffes 3, J Laseter 1, D Maldonado 1, V Ortiz-Declet 1,4, I Perets 1, B Domb 1 1 American Hip Institute, Chicago, Illinois, USA 2 Boulder Centre for Orthopedics, Boulder, Colorado, USA 3 University of Illinois at Chicago, Chicago, Illinois, USA 4 Sovereign Medical Group, Glen Rock, New Jersey, USA

2 Disclosures American Orthopedic Foundation a, American Hip Foundation a, AANA Learning Center Committee a, Adventist Hinsdale Hospital c, Hinsdale Hospital Foundation a, Hinsdale Orthopedic Associates e, Hinsdale Orthopedic Imaging e, American Hip Institute e, Arthroscopy Journal a, SCD#3 e, North Shore Surgical Suites e, Munster Specialty Surgery Center e, Amplitude c, Arthrex b,c,d, DJO Global d, Medacta b,c, Orthomerica d, Stryker b,c a boardmember; b research support; c consulting; d royalty; e ownership interest

3 Introduction - Hip Preservation is one of the fastest growing subspecialties in orthopaedics. - Due to the youth of this field, there is no consensus on how to best prepare orthopaedic surgeons for a career in Hip Preservation. - Currently, a Sports Medicine fellowship is a common way to gain additional exposure to the sub-specialty field. - The last decade has seen the advent of dedicated Hip Preservation fellowships, aimed at providing trainees with the highest level of preparation for a career including Hip Preservation. - To date and to our knowledge, there are five such programs in the United States: Boston Children s Hospital (Boston, MA), Duke University (Durham, NC), Hospital for Special Surgery (New York City, NY), University of Colorado (Denver/Boulder, CO), and the American Hip Institute (Chicago, IL). - There are an additional eight fellowships in six different countries around the world listed on the website for the International Society for Hip Preservation (ISHA)

4 Aim - To survey high volume Hip Preservation surgeons regarding their perspectives on the current and future training of surgeons entering their field.

5 Methods - Cross-sectional survey, composed of 12 questions regarding the future education of arthroscopic hip surgeons, was administrated to 16 high-volume surgeons specializing in Hip Preservation. - The questionnaire was structured to gauge opinions on the current training regimen of Hip Preservation surgeons and how it might be improved for the future. - A high-volume surgeon has been defined as an arthroscopist who performs more than 50 Hip Preservation cases annually. This study group included surgeons who had case experience ranging from 75 to 400 hip arthroscopies performed annually and a total of 250 to 3000 cases performed in their careers. - The survey asked surgeons to provide recommendations regarding (1) the ideal ways to begin Hip Preservation practice (2) the optimal amount of surgeries required for a surgeon to gain competency (3) whether arthroscopy is best practiced by Sports Medicine or hip-focused surgeons (4) the minimum number of studies that should be published by an individual fellow.

6 Results Number of Surgeries Required for Competency Procedure Mean ± SD, Range Joint Access 19.4 ± 9.1 (10-40) Labral Repair 34.3 ± 12.4 (15-50) Acetabuloplasty and Femoroplasty 53.8 ± 26.9 (20-100) Labral reconstruction ± 57.6 (10-200) Capsular closure/plication 53.3 ± 49.0 (10-200)

7 Results Acceptable Ways to Begin Hip Preservation Options No. of Surgeons % of Surgeons Weekend Course 4 25% Observation % Sports Fellowship with some Hip Preservation exposure % Dedicated Hip Preservation fellowship %

8 Results Ideal Ways to Begin Hip Preservation Options No. of Surgeons % of Surgeons Weekend Course % Observation 1 6.3% Sports Fellowship with some Hip Preservation exposure % Dedicated Hip Preservation fellowship %

9 Results Number of Cases Required for Sports Fellowship No. of Cases Mean, SD, Range Acceptable minimum 40.7 ± 15.9 (10-60) Ideal number 66.9 ± 27.2 (25-100)

10 Results Number of Optimal Surgeries Fellows Should Be Exposed To Surgery Mean, SD, Range Hip Preservation ± 64.2 (50-250) Periacetabular Osteotomy (PAO) 36.1 ± 15.6 (10-50) Hip arthroplasty ± 58.7 (30-200) Other open Hip Preservation surgeries 82.5 ± 59.6 (0-200)

11 Results Optimal Duration of a Dedicated Hip Preservation fellowship Duration No. of Surgeons % of Surgeons 3 months 0 0.0% 6 months % 12 months %

12 Conclusions - Surgeons in training, interested in Hip Preservation careers, should strongly consider a 12-month dedicated Hip Preservation fellowship that provides exposure to 128 cases, both open and arthroscopic techniques, hip arthroplasty, as well as research opportunities. - A Sports Medicine fellowship that offers a volume of 67 hip preservation cases is adequate, but possibly not ideal. - Mid-career surgeons, should be cautious about adopting Hip Preservation into their practice if they have not had prior adequate training.

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