Simulated hip arthroscopy skills: learning curves with the lateral and supine patient positions: a randomized trial.
Pollard TC., Khan T., Price AJ., Gill HS., Glyn-Jones S., Rees JL.
BACKGROUND: Hip arthroscopy can be performed with the patient in the lateral or supine position, but it remains technically demanding. We aimed to objectively quantify and compare learning curves between two groups of orthopaedic trainees randomized to learn simulated hip arthroscopy with the patient in either a lateral or a supine position. We also compared learning curves between senior and junior trainees. METHODS: A hip arthroscopy simulator with anterolateral and anterior portals, a 70° arthroscope, and fixed distraction was used. Rotation of the simulator by 90° enabled arthroscopy with the patient in a supine or lateral position. Twenty orthopaedic trainees with minimal hip arthroscopy experience were randomized into lateral and supine position groups, and were asked to perform a diagnostic hip arthroscopy of the central compartment on twelve occasions. Each episode involved a change in the portal and repetition of the diagnostic round. A validated motion analysis system objectively measured surgical performance by recording time taken, total path-length of the hands, and number of hand movements. RESULTS: Both groups demonstrated learning with objective improvement in all parameters (p < 0.001). Initially, the lateral group was significantly slower and more variable in their performance during the second diagnostic round, after portal exchange (p = 0.006). However, they achieved parity with the supine group in all parameters by nine episodes. During the first three episodes, the junior trainees performed significantly worse for the first diagnostic round (p = 0.005) but not for the second diagnostic round (p = 0.200), and they rapidly achieved parity with the senior trainees, performing at a similar level by the end of the study period. CONCLUSIONS: Trainees with minimal experience with hip arthroscopy progressively learn and objectively improve their performance when using a hip simulator. Orientation after portal exchange is difficult for all trainees but particularly for those learning with a simulated patient lateral position. Trainees are likely to benefit from simulator training to learn orientation and basic competence prior to performing hip arthroscopy on patients.