Largest Hip Arthroscopy Study Shows Improved Outcomes
One surgeon…1, 155 arthroscopies. Benjamin Domb, M.D., founder of the American Hip Institute, recently presented his clinical outcomes study at the American Orthopedic Society for Sports Medicine (AOSSM). This study represents the largest series of patients undergoing hip arthroscopy by a single surgeon. Dr. Domb tells OTW, “Hip arthroscopy is a relatively new field and is still finding its place in the world. In the first few years there was an understandable amount of skepticism about the procedure; as the field evolves, clinical data is critical to establishing its role. For this study, all of the primary and revision arthroscopies were performed from February 2008 to June 2012, and then we conducted a two-year minimum follow-up. After exclusions, we ended up with 328 men and 593 women in the study.”
“We found a statistically significant improvement in all patient reported outcomes, a decrease in patient pain and an increase in patient satisfaction. And, importantly, 94.4% of patients were able to avoid a hip replacement.”
“I generally consider hip arthroscopy for patients who don’t have any significant arthritis; it is not appropriate for patients with too much cartilage damage. We also did find that the higher the age the greater likelihood of failure.”
“We are now working on a statistical breakdown of the predictors of success, and are creating a predictive calculator to be used for prognosis and risk assessment. This will allow surgeons to use preoperative parameters to calculate the risk of conversion to hip replacement. We are also performing a logistic regression evaluation of all 41 prognostic factors in order to create a predictive model that will help surgeons refine the indications for hip arthroscopy.”
“During the early days of arthroscopy, a famous surgeon called the arthroscope ‘the tool of the devil.’ We experienced a little of that skepticism in hip arthroscopy as well over the past decade. However, we now have clinical outcomes data showing reproducible results, and hip arthroscopy is no longer the ugly stepchild of sports medicine.”
Coaching With Head-Mounted Video
It might be one of those knock-yourself-on-the-forehead occasions. With all of the teachable moments in orthopedic education, it’s a shame that we haven’t found a way to preserve them. Enter Matthew Karam, M.D., vice chair of education at the University of Iowa Hospitals and Clinics. He tells OTW, “Other fields, such as professional sports, routinely make use of video capture and review, and we thought it would be an excellent way to document the many learning situations that trainees undergo each day.”
Dr. Karam, who will soon be the Orthopaedic Surgery Residency Program Director at the University of Iowa, has just published a study in The Journal of Bone and Joint Surgery. He tells OTW, “Despite the increasing clamor for validated educational tools and methodologies, video coaching is almost unheard of. So we decided to see if one-on-one faculty/resident coaching review of a head-mounted video recording on an articular fracture simulation trainer would improve resident performance. What we have done has never before been described in such detail in the orthopedic literature.”
“We had 15 first-year and second-year orthopedic residents reduce and fix a standardized intra-articular tibial plafond fracture model under fluoroscopic guidance. Eight of the residents reviewed their videos with an orthopedic traumatologist; seven residents did not. Then each of the residents performed the reduction and fixation once more.”
“We compared the performance of the two groups on task duration, number of fluoroscopic images, and scores on the Objective Structured Assessment of Technical Skills (OSATS). The OSATS scores were assessed by fellowship-trained orthopedic traumatologists blinded to the residents’ year in training or prior surgical experience.”
“The residents who had undergone the video coaching showed statistically significant improvements in their OSATS scores as compared with the residents who had no such coaching. The coached residents also used less fluoroscopy than those who were not coached. There was no difference in task duration between the two groups.”
“In a lab it is hard to control and measure such an intervention. This is learning beyond the lab…we are pushing things forward by moving video coaching into, and even out, of the OR. Patients must sign a consent prior to surgery. At present we are developing a web based platform in order to keep everything organized; it will have a star rating system (like Amazon) for various subpoints of the procedure (which can also be time-stamped and labeled with comments).”
“The residents have found this coaching to be an exceptional experience as they are able to learn in an anxiety-free environment. This experiment was a contributing factor to our group spearheading the Midwest Orthopaedics Surgical Skills (MOSS) Consortium, an approximately 15 program member group primarily located within the Midwest region. This group is dedicated to sharing best educational practices and conducting surgical skill simulation and educational related research.”
“As for cost, this is not an expensive program to implement. It requires ‘champions’ in an orthopedic department, a GoPro camera, some video editing…and that’s about it. We should not be leaving the preservation of teachable moments to chance. If they are appropriately documented they will serve to educate generations of future surgeons and hopefully enhance the quality of our collective patient care.”
HSS Scores #1 Place for 6th Year in a Row
How do they do it? For six years running, Hospital for Special Surgery (HSS) has been ranked the top hospital in the country for orthopedics by U.S. News & World Report.
In the July 21, 2015 news release, Louis A. Shapiro, president and CEO of Hospital for Special Surgery, stated, “We are honored to receive the top national recognition in orthopedics with unprecedented consistency, which is an indication of our commitment to delivering value to all patients. And, we are proud that HSS is the choice among patients who want to live life to the fullest. Our patients travel for our care from all 50 U.S. states and from more than 100 countries worldwide.”
“This accolade is a testament to the work of all HSS staff who help patients get back to their own game of life every day, ” added Todd J. Albert, M.D., surgeon-in-chief and medical director of Hospital for Special Surgery. “The entire clinical process at HSS—and all services we provide for patients—is developed to advance care, research, and education in our specialty field of musculoskeletal medicine.”
Lou Shapiro told OTW, “The success of HSS comes from the over 4, 000 people who work here; everyone is fully invested in our success. Each one has a mindset of commitment, and the people who call HSS their professional ‘home’ are highly involved in the daily decision making. We have physicians on the Board of Directors, multidisciplinary committees, and an amazing amount of data and dashboards that guide how we measure and manage—and how we lead and drive continuous improvement—across everything we do.”
“I am also proud of the fact that for 27 consecutive quarters we have been in the 99th percentile for patient satisfaction (based on the question, ‘How likely are you to recommend HSS?’). Our employees (members of the HSS Team) are also quite engaged, as shown by two consecutive Gallup ‘Best Workplace’ awards. We have grown to the point where patients seek us out from all 50 states and 100 foreign countries. That could only happen if all of the pieces of the puzzle are working together. This culture of striving for perfection that we have built emanates from our fundamental philosophy that we cannot rest on our achievements. We briefly celebrate our successes and then turn our attention toward how we can improve going forward.”
