Portal Setup: the Key Point in the Learning Curve for Hip Arthroscopy Technique

Postless Distraction Technique With No Additional Equipment in Hip Arthroscopy

Hip arthroscopy has become a predominant treatment for hip disorders such as femoroacetabular impingement syndrome and labral injury, and appropriate distraction for the hip joint is necessary for successful surgery. The traditional distraction method uses a perineal post but may cause complications such as perineum injury and nerve damage. For this reason, some surgeons have proposed postless distraction techniques, but they usually require additional equipment purchase and cost, which is not conducive to application. Therefore, we developed a post-free distraction technique without additional equipment. This method uses only surgical draw sheets, safety straps, a hip fracture table, and a hip distractor that are routinely provided in the operating room, and postless hip distraction can be achieved by using the Trendelenburg position, which is reliable, simple, and reproducible to be used in hip arthroscopy.

THE STATE OF HIP ARTHROSCOPY IN RUSSIA: ASSESSMENT BASED ON A SOCIOLOGICAL SURVEY OF DOCTORS

Background.Hip arthroscopy is a minimally invasive surgical technique most commonly performed to correct femoroacetabular impingement (FAI). The number of hip arthroscopy performed in Russia is unknown. Information about this surgical technique is also very limited in our country.The aim of the study was to assess the level of hip arthroscopy in Russia.Methods.A sociological survey of orthopaedic surgeon with experience in performing hip arthroscopy was conducted. The questionnaire was posted on the Google Forms platform. The survey included 54 surgeons from Russian clinics, 45 people filled out the questionnaire.Results.The majority of specialists (73,30,06%) were trained in hip arthroscopy. More than half of the respondents (68,80,06%) are currently engaged in this surgical area, however, in 45,160,07% of them, the number of operations does not exceed 5 per year. For surgeons who have completed two or more training courses, the volume of operations performed is higher (p0,05). 51,110,07% of doctors perform arthroscopy using an alternative technique. There are 2,5 time more specialists doing just bone resection, than surgeons who apply any kind of reconstruction technique while treating FAI (p0,05). Fifteen respondents (48,390,08%) perform debridement as an attempt to delay arthroplasty. The most common difficulties faced by surgeon are problems with the diagnosis of FAI (400,02%), lack of the necessary tools (400,02%) and sufficient time to master the technique (33,30,07%). Only three (6,60,07%) respondents believed to achieve planned results, 93,30,03% of surgeons said that it is not always possible to achieve the desired outcomes.Conclusion. Hip arthroscopy in Russia is not very common, the volume of such interventions is insignificant. Doctors not skilled in arthroscopic hip surgery predominate. Factors impeding the development of this area in our country are related to teaching methods, FAI diagnostics, the lack of necessary instruments for performing operations, and the lack of time for specialists to master surgical techniques.

Eye tracking metrics of orthopedic surgeons with different competency levels who practice simulation-based hip arthroscopic procedures

Objective

This study aimed to investigate the feasibility of using eye tracking data to identify orthopedic trainees' technical proficiency in hip arthroscopic procedures during simulation-based training.

Design

A cross sectional study.

Setting

A simulation-based training session for hip arthroscopy was conducted. Eye tracking devices were used to record participants' eye movements while performing simulated operations. The NASA Task Load Index survey was then used to measure subjective opinions on the perceived workload of the training. Statistical analyses were performed to determine the significance of the eye metrics and survey data.

Participants

A total of 12 arthroscopic trainees, including resident doctors, junior specialist surgeons, and consultant surgeons from the Department of Orthopedics in five hospitals, participated in this study. They were divided into three subgroups based on their prior clinical experience.

Results

Significant differences, including those for dwell time, number of fixations, number of saccades, saccade duration, peak velocity of the saccade, and pupil entropy, were observed among the three subgroups. Additionally, there were clear trends in the perceived workload of the simulation-based training based on feedback from the participants.

Conclusion

Based on this preliminary study, a correlation was identified between the eye tracking metrics and participants' experience levels. Hence, it is feasible to apply eye tracking data as a supplementary objective assessment tool to benchmark the technical proficiency of surgical trainees in hip arthroscopy, and enhance simulation-based training.

A three-dimensional (3D) printed simulator as a feasible assessment tool for evaluating hip arthroscopy skills

PURPOSE

The aims of this study were (1) to develop a three-dimensional (3D) printed simulator that facilitates the simulation of surgical skills for portal placement, intra-articular identification of anatomical structures and arthroscope navigation for hip arthroscopy and (2) to concurrently examine the feasibility of using this simulator as an assessment tool to evaluate trainees' surgical competencies.

METHODS

A simulator was developed using a combination of medical imaging, computer-aided design, and 3D printing. A cross-sectional study was conducted with 29 participants divided into 3 subgroups (novice, intermediate and experienced). All participants performed related skills on the simulator, and their performance was evaluated using different assessment parameters. The participants' qualitative feedback regarding the simulator was also collected. The data collated from each group of participants were subsequently compared.

RESULTS

Significant differences were observed between the three subgroups of participants with regard to the total checklist score (F_2,26 = 11.3), total Arthroscopic Surgical Skill Evaluation score (F_2,26 = 92.1), overall final global rating scale score (F_2,26 = 49), number of times the participants used fluoroscopy (F_2,26 = 7.4), and task completion times (F_2,26 = 23.5). The participants' performance in the simulated operation was correlated with their prior clinical experience. There was mainly positive feedback with regard to the fidelity and utility of the simulator in relation to the surgeons' prior clinical experience.

CONCLUSIONS

This study demonstrated that a reliable hip arthroscopic simulator can be developed for use by orthopedic surgeons to evaluate their hip arthroscopic skills before performing actual surgical operations.

LEVEL OF EVIDENCE

Level III.