KSSTA - 2026-06-26 - Journal Article
Surgeon experience in hip arthroscopy improves operative efficiency and reduces conversion to total hip arthroplasty: A meta-analysis.
Ramadanov N, Heinz M, Hable R, Becker R, Banke IJ
Topics
Key Takeaway
Experienced hip arthroscopy surgeons (late-phase cases) achieved 31.77 minutes shorter operative time and a 90% reduction in THA conversion rate (OR 0.10) compared to early-phase cases across 2,624 procedures.
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Summary
This PRISMA-registered meta-analysis examined whether surgeon experience phase (early vs. late) in hip arthroscopy affects operative efficiency, functional outcomes, complications, and THA conversion. Random-effects meta-analysis using Sidik-Jonkman/Hartung-Knapp methods showed late-phase surgeons had significantly shorter operative time (-31.77 min) and traction time (-15.67 min), with modest but statistically significant functional gains including MCID improvement (0.58 units), mHHS (+2.78 points), and NAHS (+8.41 points). THA conversion was markedly lower in late cases (OR 0.10), though complication and revision arthroscopy rates did not differ significantly.
Key Limitation
The learning curve threshold (early vs. late phase) was defined inconsistently across included studies, making it impossible to specify a validated case-number cutoff at which outcomes stabilize.
Original Abstract
PURPOSE
Hip arthroscopy (HAS) is technically demanding, and surgeon's experience may influence outcomes. However, the magnitude and domain-specific effects of the learning curve remain unclear.
METHODS
A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD420251185937). PubMed/MEDLINE, Embase and Scopus were searched through 31 December 2025 for studies comparing early versus late experience phases in HAS. Random-effects meta-analyses (Sidik-Jonkman estimator with Hartung-Knapp adjustment) were performed for operative and traction time, patient-reported outcomes, complications, revision arthroscopy and conversion to total hip arthroplasty (THA). Risk of bias was assessed using ROBINS-I and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS
Eighteen studies (2624 procedures; 1291 early and 1333 late cases) were included. Late cases showed significantly shorter operative time (-31.77 min; 95% confidence interval [CI] -51.40 to -12.14) and traction time (-15.67 min; 95% CI -25.42 to -5.92), with substantial heterogeneity. Functional outcomes favoured late experience, including higher improvement in minimal clinically important difference units (0.58; 95% CI 0.17 to 0.99) and modest gains in modified Harris Hip Score (2.78 points; 95% CI 0.16 to 5.41) and Non-Arthritic Hip Score (8.41 points; 95% CI 1.99 to 14.83). Complication rates and revision arthroscopy did not differ significantly, whereas conversion to THA was lower in late cases (odds ratio [OR] 0.10; 95% CI 0.01 to 0.98). Most studies were at moderate to serious risk of bias, and certainty of evidence was low to very low.
CONCLUSION
Surgeon experience in HAS is associated with improved operative efficiency and modest functional gains, while safety outcomes remain largely unchanged. The lower THA conversion rate in late cases may reflect improved patient selection and decision-making, although confidence is limited by study design and heterogeneity.
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.