Who Is Performing Hip Arthroscopy? An Analysis of the American Board of Orthopaedic Surgery Part-II Database

Background: Hip arthroscopy utilization has increased dramatically over the last decade. However, the lack of a formal training curriculum raises concern that inconsistent technical performance may be an issue for early-career hip arthroscopists. The purpose of the present study was to investigate hip arthroscopy utilization by early-career orthopaedic surgeons while focusing on fellowship training status to better guide future development of a hip arthroscopy training curriculum. Methods: The American Board of Orthopaedic Surgery (ABOS) Part-II database was used to identify candidates who had performed >= 1 hip arthroscopy procedures between 2006 and 2015. Procedures were categorized using Common Procedural Terminology (CPT) codes, and candidates were categorized by fellowship training experience. Trends in hip arthroscopy utilization were evaluated using univariate and regression analyses while stratifying by fellowship training experience. Results: Overall, 9.2% (643) of 6,987 ABOS candidates had performed >= 1 hip arthroscopy procedures. Over the study period, both the proportion of candidates performing hip arthroscopy and the proportion of hip arthroscopy procedures performed (relative to all procedures performed, of any type) increased (p < 0.001). Candidates performing hip arthroscopy most frequently reported sports medicine fellowship training (74.5%; 479 of 643). Also, among the candidates who performed hip arthroscopy, the proportion who had sports medicine fellowship training increased over the study period (p = 0.001). The majority of candidates performing hip arthroscopy (67.2%; 432 of 643) performed <= 5 hip arthroscopy procedures, while a small number of high-volume hip arthroscopists (6.5%; 42 of 643) performed 34.6% (1,403 of 4,054) of all hip arthroscopy procedures. Conclusions: The increase in hip arthroscopy utilization in this cohort appears to have been driven primarily by the increased number of candidates performing hip arthroscopy and less by an increasing number of hip arthroscopy procedures being performed by individual candidates. The majority of candidates performing hip arthroscopy were sports-medicine- fellowship trained. This information is valuable for both trainees and educators interested in improving education and \defining a curriculum for future hip arthroscopy training.