Impact of Surgeon Volume on Perioperative Complications and Survival to Total Hip Arthroplasty Following Femoral Head Core Decompression

Abstract

Introduction: Core decompression is a minimally invasive procedure considered in the treatment of early-stage femoral head osteonecrosis. This procedure is theorized to relieve vascular pressure and promote angiogenesis. Although a less invasive procedure, there are considerations related to learning curve, technique variations, etc. that may affect postoperative complications and longer term adverse events. Methods: Adult patients who underwent core decompression with a diagnosis of femoral head osteonecrosis were identified in the 2010-Q3 2021 PearlDiver M157 database. Core decompression surgeon volumes over the entire study period were assessed and divided into ranges: low (<5 procedures), medium (5 ≤ x ≤ 19 cases), and high (>19 cases) volumes. A 1:1:1 match based on age, sex, and Elixhauser Comorbidity Index was completed. Rates of 90-day complications were compared with univariable and multivariable analyses. Survival to total hip arthroplasty (THA) and to subsequent hip fracture at both 2 and 5 years were compared by Kaplan-Meier survival analysis. Results: The low-volume, medium-volume, and high-volume surgeon groups made up 87.5%, 11.9%, and 0.2% of core decompression volume, respectively. This was indicative of 6333 patients undergoing core decompression, and matching based on the surgeon-volume category led to 486 patients per group. No statistically significant differences were observed in shorter term complications and survival to THA or hip fracture at 2 or 5 years. Conclusion: Core decompression is a treatment option often considered for early-stage osteonecrosis. Critically, no differences were found in rates of any assessed complications between the surgeon-volume matched cohorts. These findings suggest that core decompression is a relatively safe procedure for surgeons of varying volume with this technique. Furthermore, this study suggests that higher volume surgeons are not conducting the procedure with expanded indications that might result in greater rates of conversion to THA.