Orthopaedic Surgery Sports Medicine Fellows See Substantial Increase in Hip Arthroscopy Procedural Volume with High Variability from 2011-2016

Purpose: To analyze the trends in operative experience, specifically procedures of the shoulder, hip and knee, of fellows graduating from Accreditation Council for Graduate Medical Education (ACGME) orthopaedic sports medicine fellowships between 2011 and 2016.

Methods: The 2011-2016 ACGME orthopaedic surgery sports medicine fellow case logs were retrieved for analysis. Trends in the mean case volume for procedures of the shoulder, hip, and knee were analyzed. Linear regression was used to identify significant changes in trends over time for each surgical case/procedure. Variation in case volume between fellows in the lowest (10th) and highest (90th) centile was assessed for first and last year of the study.

Results: The average number of total procedures per fellow minimally decreased by 3.5% from 2011 to 2016 (726 to 701 cases) (p<0.001). The mean total number of hip procedures significantly increased by 155% from 24.9 to 63.5 (p =0.049). There were no significant differences in the mean total number of shoulder (p=0.88) and knee procedures (p = 0.54). Arthroscopic hip procedures had the largest increase from 2011 to 2016 (14.1 to 57.8 (+310%), p =0.049). There was greater than 2-fold difference in total procedural volume between fellows in the 10th and 90th percentile for 2011 and 2016, with the greatest variation (64-fold) for arthroscopic hip procedures.

Conclusion: In this study there was a 2.6-fold increase in hip procedures, largely driven by a 310% rise in arthroscopic hip cases. The average procedural volume per fellow minimally decreased, with no change in the mean number of shoulder and knee procedures.

Keywords: arthroscopy; case log; fellowship; sports medicine; trends; variability.