EP9.19 Structured Introduction of a Young Surgeon to Hip Arthroscopy: A Stepwise Training Model

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ID: 331204
2026
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Abstract
Abstract Background Hip arthroscopy has a steep learning curve due to deep joint access, constrained working space, and technically demanding portal placement. Early complications are commonly related to portal establishment and iatrogenic intra-articular injury. This study presents a structured model for safe and progressive introduction of a trainee surgeon, focusing on key threshold skills. Methods A retrospective review of a prospectively maintained hip arthroscopy registry was performed. The senior surgeon (RK) established an independent program in 2014 and has performed over 250 hip arthroscopies; the trainee surgeon (NK) joined after 2020. NK has prior experience in THA using the direct anterior approach (DAA), facilitating anatomical understanding and anterior access principles. RK is an experienced hip arthroscopist with extensive arthroplasty background. Complementary education included international meetings and S2S observerships. Training followed a controlled pathway: Phase 1 – Foundations: Patient positioning on the traction table, safe joint distraction under fluoroscopy, portal placement, three-dimensional spatial orientation, capsulotomy, and diagnostic arthroscopy. Phase 2 – Modular skills: Stepwise execution: iliopsoas tenotomy and labral debridement → CAM/Pincer osteoplasty and labral repair. Progression required reproducibility. Phase 3 – Controlled independence: Early independent cases were limited to iliopsoas tenotomy and labral debridement, initially with mentor assistance. Phase 4 – Full independence: Gradual progression to complex intra-articular procedures, including labral repair and combined corrections. Between 2020–2026, NK assisted in the majority of RK’s procedures, performing defined steps under supervision. In parallel (2022–2026), NK performed 25 independent procedures (40% iliopsoas tenotomy, 32% debridement/osteoplasty, 20% labral repair, 8% other), progressing to fully independent practice with RK available on-call. Key technical insights Accurate patient positioning and portal placement are critical threshold skills. Proper positioning ensures safe traction and adequate joint distraction, while even small deviations in portal trajectory significantly compromise access. Early phases require sufficient working space; advanced stages emphasize controlled capsular management to avoid microinstability. Conclusion A structured training model combining supervised skill acquisition, extensive assisted experience, staged independence, and on-call mentorship enables safe progression in hip arthroscopy. DAA experience may facilitate skill transfer. Patient positioning and portal placement should form the foundation of training programs.
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Authors Nejc Kurinčič, Klemen Ravnihar
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.499
URL
https://doi.org/10.1093/jhps/hnag043.499
Keywords Keywords not found

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