From August 2009, all doctors were subject to the European Working Time Directive (EWTD) restrictions of 48 hours of work per week. Changes to rota patterns have been introduced over the last two years to accommodate for these impending changes, sacrificing ‘normal working hours’ training opportunities for out-of-hours service provision. We have analysed the elogbook data to establish whether operative experience has been affected. A survey of trainees (ST3-8) was performed in February 2009 to establish shift patterns in units around the UK. All operative data entered into the elogbook during 2008 at these units was analysed according to type of shift (24hr on call with normal work the following day, 24hr on call then off next working day, or shifts including nights). 66% of units relied on traditional 24hrs on call in February 2009. When compared with these units, trainees working shifts had 18% less operative experience (564 to 471 operations) over the six years of training, with a 51% reduction in elective experience (288 to 140 operations). In the mid years of training, between ST3-5, operative experience fell from 418 to 302 operations (25% reduction) when shifts were introduced. This national data reflects the situation in UK hospitals in 2009, prior to the implementation of a maximum of 48 hours. It is expected that most hospitals will need to convert to shift-type working patterns to fall within the law. This could have significant implications for elective orthopaedic training in the UK

Background: From August 2009, all doctors were subject to the European Working Time Directive (EWTD) restrictions of 48 hours of work per week. Changes to rota patterns have been introduced over the last two years to accommodate for these impending changes, sacrificing ‘normal working hours’ training opportunities for out-of-hours service provision. We have analysed the elogbook data to establish whether operative experience has been affected. Methods: A survey of trainees (ST3-8) was performed in February 2009 to establish shift patterns in units around the UK. All operative data entered into the elogbook during 2008 at these units was analysed according to type of shift (24hr on call with normal work the following day [traditional on call], 24hr on call then off next working day, or shifts including nights). Results: 66% of units relied on traditional 24hrs on call in February 2009. When compared with these units, trainees working shifts had 18% less operative experience (564 to 471 operations) over the six years of training, with a 51% reduction in elective experience (288 to 140 operations). In the mid years of training, between ST3-5, operative experience fell from 418 to 302 operations (25% reduction) when shifts were introduced. Discussion: The eLogbook is a powerful resource that provides accurate data for the purpose of supporting orthopaedic training. This national data reflects the situation in UK hospitals in 2009, prior to the implementation of a maximum of 48 hours. It is expected that most hospitals will need to convert to shift-type working patterns to fall within the law. This could have significant implications for elective orthopaedic training in the UK

Background. Every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland records their operative experience via the Faculty of Health Informatics eLogbook. Since August 2009, all doctors were subject to the full European Working Time Directive (EWTD) restrictions of 48 hours of work per week. We have previously shown that the implementation of shift working patterns in some units in preparation for these restrictions reduced training opportunities by 50% (elective surgical exposure). We have now analysed the national data to establish whether operative experience has fallen since August 2009. Methods. All operative data recorded nationally by trainees (all years, all supervision levels) between the 3 months of August to October 2007, 2008 and 2009 were compared. Data were available for 1091 ‘validated’ training grade surgeons (ST3-8 or equivalent) in 2007, 1103 in 2008 and 767 in 2009. Mean operative figures were calculated per trainee for each of the 3-month time periods. Results. During the three study periods trainees performed an average of 63 (2007), 62 (2008) and 65 (2009) operations, and total operative exposure was 102, 101 and 107 respectively. There was an increase in operative exposure of 5% from 2007 to 2009. Trauma represented 44% (2007), 41% (2008) and 42% (2009) of total exposure. Conclusion. This national data shows that, in the 3 months following implementation of the 48-hours EWTD restrictions, the expected decrease in operative exposure did not occur. This may be a result of the introduction of rotas to maximise theatre exposure, whilst minimising other commitments, such as outpatient experience. Alternatively, there may be widespread disregard for shift working and hours restrictions in order to maintain adequate operative exposure. Despite the implementation of the full EWTD restrictions, it appears that T&O trainee operative exposure in the first three months has not fallen

It has been suggested that recent reduction in hours worked by orthopaedic trainees in the UK may result in less exposure to operative procedures. To examine this possible change, operative data showing the participation of specialist registrars in orthopaedic trauma cases were examined over 6-month periods in 2002 and 2007. Operations specifically examined included dynamic hip screw, hip hemiarthroplasty, manipulation under anaesthetic, ankle fracture fixation, and tension band wiring. A traditional on-call system was used throughout but the number of working hours was reduced. Analysing individual operations, the results demonstrated a general trend for trainees to perform fewer procedures in the 2007 group, but this difference was not statistically significant. Level of consultant supervision was not significantly different except for hip hemiarthroplasty, which was higher in 2007. When considering all operations together, there was a significant decrease in the number of procedures performed by trainees in 2007, and although there was a trend for more supervision, this was not significant. Trainees were present for a significantly lower proportion of procedures in 2007 than 2002. We conclude that it appears operative experience in orthopaedic trainees may be less than 5 years ago and this may be associated decreased attendance in theatre

Purpose

Case logs have been utilized as a means of assessing residents surgical exposure and involvement in cases. It can be argued that the degree of involvement in operative cases is as important as absolute number of cases logged. A log which contains accurate information on actual participation in surgical cases in addition to self reported competency, is a powerful tool in obtaining a true reflection of surgical experience. Thus a prerequisite for a valuable log is the ability to perform an accurate self-assessment. Numerous studies have shown mixed results when examining residents ability to perform self-assessment on varying tasks. The purpose of the study was to examine the correlation between residents self-assessment and staff surgeons evaluation of surgical involvement and competence in performing primary hip and knee arthroplasty surgery.

Aims

The aim of this study was to explore differences in operative autonomy by trainee gender during orthopaedic training in Ireland and the UK, and to explore differences in operative autonomy by trainee gender with regard to training year, case complexity, index procedures, and speciality area.

In June 2012 the Orthopaedic Speciality Advisory of the Joint Committee on Surgical Training defined ‘minimum indicative numbers’ that trainees would have to meet before completion of specialist training. It has been speculated that regions have varied in their ability to provide operative opportunities to their trainees. This study aims to test the hypothesis that there are regional differences in operative training experience. The eLogbook database was interrogated for cases over a 12 month period from 7 August 2013 to 5 August 2015. Within each region, the mean of the cases registered by orthopaedic trainees in each year of training during the study period was calculated and summed to give a representative surgical experience for the years ST3-8. First surgeon only cases were analysed for 11 index procedures in 30 T&O rotations. Considerable variation in training existed across rotations. In three index procedures, including DHS, no rotation achieved the minimum indicative number required. All rotations achieved the minimum indicative number of external fixator applications. This study proves the extent of the significant regional variation in surgical training in Trauma and Orthopaedics in the UK and raises concerns regarding the volume of operative training currently achieved

Introduction: In August 2007, the Department of Health initiative Modernising Medical Careers was implemented. This was a system of reform and development in postgraduate medical education and training. In preparation for the changes, the SAC for T& O outlined a new curriculum. The emphasis of early training, StR years 1 and 2, was to be trauma. We aim to identify how effectively the SAC proposals are being applied, and what difference this makes to the trainees’ operative experience? Furthermore, how do the new posts compare to the historic SHO models?. Methods: A survey carried out by BOTA allowed us to assess post compliance with the SAC recommendations. A compliant job was defined as trauma based for 50% or more of working time. Consent was obtained to evaluate the eLogbooks of trainees in compliant and non-compliant jobs, along with registrars who had previously held traditional SHO grade posts. Overall operative experience over a specified 4 month time period was examined, with focus on routine trauma procedures. Results: The results of the BOTA and SAC survey revealed that 45% of the new orthopaedic posts were compliant with curriculum guidelines. The eLogbooks of 92 individuals were analysed; 28 historical posts, 34 compliant and 30 non-compliant. The mean total number of recorded entries by trainees in the 4 month period was 73.2 in the historic group, 90.5 in the compliant and 87.3 in the non-compliant job group. The corresponding numbers of trauma operations were 35.7, 48.4 and 41.5. Conclusions: Operative experience has improved since the introduction of the new curriculum. The new posts are offering more operative and in particular trauma exposure than traditional SHO jobs. If jobs can be restructured such that they all comply with the SAC, educational opportunities in the early years will be maximised

Since 2003 Trauma and Orthopaedic trainees in the UK and Ireland have routinely submitted data recording their operative experience electronically via the eLog-book. This provides evidence of operative experience of individuals and national comparisons of trainee, trainer, hospital and training programme performance. We have analysed trauma surgery data and established standards for training. By January 2008 there were over 4 million operations logged. Operations performed and uploaded since 2003 have been included. Each trainee’s work is analysed by ‘year-in-training’. Data on levels of supervision, missed opportunities (where the trainee assisted rather than performed the operation) was analysed. The average number of trauma operations performed annually by trainees was 109, 120, 110, 122, 98 and 84 (total 643) for YIT one (=ST3) to six (=ST8) respectively. There were only 22% of missed opportunities throughout six years of training. A high level of experience is gained in hip fracture surgery (121 operations) and forearm (30), wrist (74) and ankle (47) operative stabilisation over the six years. However, the average number of tibial intra-medullary nails (13), external fixator applications (12) and childrens’ elbow supracondylar fracture procedures (4) performed is low. We are also able to identify trainees performing fewer operations than required during their training (two standard deviations or more below the mean for their YIT). We expect a trainee to have performed at least 255, 383, 473, and 531 trauma operations at the end of YIT three to six respectively. The eLogbook is a powerful tool which can provide accurate information to support in-depth analysis of trainees, trainers, and training programmes. This analysis has established a baseline which can be used to identify trainees who are falling below the required operative experience

Centre Hospitalo-Universitaire de Lille, Service de Neurochirurgie et Chirurgie du Rachis, Lille, France. Assessment of current thoughts regarding spinal fellowships amongst spinal fellows in the United Kingdom and abroad. Qualitative analysis provides rich and contextual detail that cannot be borne out by quantitative research. We undertook detailed interviews amongst fellows who have varying fellowship experience both in the United Kingdom and abroad. Ten fellows, all of whom were approaching their Certificate of Completion of Training (or equivalent) in Trauma and Orthopaedic surgery, or just awarded the certificate. All undertaking/undertaken at least one 12-month fellowship. Qualitative experiences. A large unit provides a breadth of pathology that may is usually not encountered in smaller units. Fellows who worked in such units felt confident that they would recognise a variety of pathologies, but did not necessarily feel confident in their surgical management. Operative exposure to deformity surgery, whilst not necessarily a future part of practice, was felt useful for the added technical skills it provides. Fellows attending a smaller unit, where they may have been the sole ‘spinal fellow’, reported greater satisfaction in operative experience. Interestingly, there was felt to be a ‘saturation point’, where a fellow perceived no further educational benefit from remaining in one particular unit. A fellowship in spinal surgery is useful in preparing for independent practice as a spinal surgeon. Large units provide skills that are applicable to several aspects of spinal surgery. There appears to be a difference in breadth and complexity of pathology versus operative experience

Aims

To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture.

Open reduction of DDH is indicated in late presenting cases and those who fail Pavlik Harness treatment, if closed reduction is unsuccessful. Recognised techniques involve excision of the ligamentum teres to allow maximal medialisation of the femoral head into the acetabulum. We describe a new technique in which the ligament’s femoral attachment is preserved and the medial end is passed through the incised transverse ligament. Gentle traction on the medial end is used to aid reduction and when sutured to the anterior capsule, the reduction is stabilised. We present our operative experience and early follow up of 8 cases

Surgery for spinal deformity was previously carried out only in teaching hospitals in the United Kingdom. With increasing numbers of patients especially adults, seeking treatment for spinal deformity, the number of centres offering treatment for spinal deformity is going to have to increase. The deformity part of the Spinal Surgical Service in the District General Hospital in Taunton started in 2005. This paper is an audit of this deformity service. It looks at two key areas – that of patient satisfaction and patient reported outcomes of surgery. Patient satisfaction was assessed by a validated questionnaire that evaluated a patient's perception of consultations, consent, preoperative assessment, operative and post operative experience and follows up visits. Patient reported outcomes were evaluated using the SRS 30 questionnaire. 104 patients were contacted and 95 patients (91%) responded. The overall patient satisfaction rate was 96%, with 87% very pleased with the result of surgery, 80% felt that their body shape had improved considerably, 62% had an increased ability to carry out day to day activities to a much higher level and 78% had significantly decreased pain after surgery. The results of the different domains of the SRS questionnaire also supported this. The authors believe that this audit proves that it is possible to provide a spinal deformity service in a District General Hospital in the United Kingdom safely and effectively with a high degree of patient satisfaction. Audits of this kind are required to compare results of treatment between different centres and establish standards

Purpose: To describe operative experience and reductions of pelvic ring fractures treated with a novel pelvic reduction frame. Method: All patients with displaced pelvic ring disruptions treated with the pelvic reduction frame were included. The series includes 35 patients, with 34 acute fractures and one malunion. Pre-operative and immediate post-operative radiographs were reviewed, and maximal displacement measured using two reproducible methods. Procedure and injury data were also recorded. Results: In our series of 35 patients, we had 19 vertical shear fractures and 16 compression injuries. Mean age was 33.5 + 2.4, and mean delay to surgery was 4.7 + 0.6 days. Mean operative time in isolated procedures was 103.4 + 6.5 minutes. All but one patient had iliosacral screws placed, 18 had anterior column screws, six had symphysis plates and 12 had anterior external fixators. Maximum horizontal or vertical displacement was improved from 30.8 + 2.7 mm to 7.1 + 0.7 mm. Diameter asymmetry as measured on the AP view was improved form 26.4 + 2.7 mm to 5.2 + 0.7 mm. Very good, good or fair reduction was obtained in all acute cases. There was no statistically significant impact of obesity, fracture type or delay to surgery on quality of reduction (p> 0.05). Conclusion: This novel pelvic reduction frame is a powerful tool in the effective reduction and fixation of displaced acute pelvic ring disruptions

An online survey has been carried out to evaluate the compliance with the OCAP learning tools, and the availability of clinical experience to early years’ trainees in Trauma and Orthopaedics in 2007–8. Three surveys were planned over the year, and we present the results from the first two surveys. Over the initial eight month period, 335 trainees in Trauma and Orthopaedic posts responded. There was considerable variation in the proportion of responses from different deaneries, and it was felt this reflected differences in the use of the two logbooks available (FHI or ISCP). Respondents were FTSTAs (50%), ST1s (11%) and ST2s (29%). The respondents reported their operative experience was poor with low numbers of index procedures – the median values being 2 DHS, 1 Hemiarthroplasty and 0 for Ankle ORIFs performed as the lead surgeon in the first 4 months, rising to 3, 1 and 1 respectively in the second. As an assistant the numbers were 3, 4 and 3. FTSTAs had done more procedures as lead surgeon. It is not clear whether this reflects motivation, or whether they are trainees who were unable to secure training posts due to seniority and were already more experienced. Many posts were entirely ward based. Improvements in meetings with Assigned Educational Supervisors were noted, as was the use of the learning agreements, and with registration rates with the ISCP. There was considerable variation between posts, hospitals and deaneries, and a tool was developed to summarise this data to be post-, trainee-, and duration-specific. Summaries of each post were distributed to Training Program Directors, Heads of School, and the SAC. Although some improvement has occurred, further rounds of the survey are necessary to ensure that this continues. The next round will commence in September 2008 to complete twelve months of data

Introduction: The assessment of quality in the provision of healthcare is one of the core features of the National Health Service in the 21st Century. From April 2009 Patient Reported Outcome Measure (PROM) data are being collected for the Department of Health for elective hip and knee arthroplasty using generic and disease specific measures of health status. The perceived uses of these data may be for research, assessment of procedural outcome, measures of health inequalities and to aid commissioning groups in selecting their secondary care providers. Foot and ankle surgery covers a wide spectrum of operative procedures with patient responses less predictable than with major joint arthroplasty. We report the use of a sixteen point satisfaction-based questionnaire in order to investigate the nature of patient outcome after the processes of foot and ankle surgery. Methods: A prospective series of 100 two-part Visual Analogue Scale (VAS) questionnaires was distributed to patients undergoing elective foot and ankle surgery at the Northern General Hospital under the care of four foot and ankle surgeons over a three-month period. The questionnaires were numbered to allow patient anonymity. The first part of nine questions enquired about pre-operative preparation and information and was distributed before surgery. The second part of seven questions, distributed at the first post-operative clinic sought to investigate their hospital and operative experience. Free text comments were requested in addition to the VAS responses, which were expressed as percentages. Results: 97% of part one and 85% of part two questionnaires were returned completed. 82% had both parts completed and matched. The day case to inpatient ratio was 55: 45. For part one, all clinically related questions scored more than 90% satisfaction, with only two scores for administration-based questions falling below this level. For part two, satisfaction for clinical questions again scored more than 90% and overall, all scored more than 80% satisfaction. Only 23% of pre-operative and 28% of post-operative questionnaires were returned with free-text comments. Conclusions: A simple patient satisfaction-based questionnaire may be as useful as existing non-validated generic scoring systems used in foot and ankle surgery when assessing quality in the health service, particularly where regional demographics or referral patterns may be important factors influencing patient outcomes. Active dialogue with the surgical colleges and Department of Health should be pursued to avoid inappropriate outcome measures being imposed in foot and ankle surgery

Aims: The aims of this prospective study was to elucidate, how the high tibial opening wedge osteotomy (OW-HTO) corrected the varus angle of the lower extremity to the desired valgus angle in arthrotic knee joint, and what are the typical complications concerning this operation method. Methods: Twenty-one patients were operated on by using the operation technique (Puddu 1998) from September 1999 to August 2000. Results: The mean preoperative femoro-tibial varus-angle of the þrst 21 patients was 1.4. degrees, immediate postoperative valgus-angle was 7.1 degrees and at the latest follow-up, the valgus angle was 5.6 degrees, respectively. In 16 of these 21 patients the healing was uneventful. Five patients sustained complications. Three patients had fracture of the opposite tibial lateral cortex peroperatively. Two of these fractures healed without complication. One of these patients needed total knee arthroplasty later on because of pseudoarthrosis and loss of OW-HTO correction angle at the osteotomy site. Two patients sustained peroperative þssural fracture up to the lateral tibial joint articulation surface. These fractures healed uneventfully. Conclusion: A group of young, active heavy patients sustaining varus gonarthro-sis are candidates for HTO. After promising results of these 21 OW-HTO operations, we have operated 34 more patients. Complication rate has dropped because of better operative experience. However, OW-HTO is a sensitive operation with itñs possible complications. In experienced hands it is reliable and good operation. Also we have to remember, that this operation allow patients to keep their own knee joint with itñs normal kinesiology

Introduction. Malpositioning of the tibial component is a common error in TKR. In theory, placement of the tibial tray could be improved by optimization of its design to more closely match anatomic features of the proximal tibia with the motion axis of the knee joint. However, the inherent variability of tibial anatomy and the size increments required for a non-custom implant system may lead to minimal benefit, despite the increased cost and size of inventory. This study was undertaken to test the hypotheses: . 1. That correct placement of the tibial component is influenced by the design of the implant. 2. The operative experience of the surgeon influences the likelihood of correct placement of contemporary designs of tibial trays. Materials and Methods. CAD models were generated of all sizes of 7 widely used designs of tibial trays, including symmetric (4) and asymmetric (3) designs. Solid models of 10 tibias were selected from a large anatomic collection and verified to ensure that they encompassed the anatomic range of shapes and sizes of Caucasian tibias. Each computer model was resected perpendicular to the canal axis with a posterior slope of 5 degrees at a depth of 5 mm distal to the medial plateau. Fifteen joint surgeons and fourteen experienced trainees individually determined the ideal size and placement of each tray on each resected tibia, corresponding to a total of 2030 implantations. For each implantation we calculated: (i) the rotational alignment of the tray; (ii) its coverage of the resected bony surface, and (iii) the extent of any overhang of the tray beyond the cortical boundary. Differences in the parameters defining the implantations of the surgeons and trainees were evaluated statistically. Results. On average, the tibial tray was placed in 5.5 ± 3.1° of external rotation. The overall incidence of internal rotation was only 4.8%: 10.5% of trainee cases vs. 0.7% of surgeon cases (p < 0.0001). The incidence of internal rotation varied significantly with implant design, ranging from 1.7% to 6.2%. Bony coverage averaged 76.0 ± 4.5%, and was less than 70% in 8.6% of cases. Tibial coverage also varied significantly between designs (73.2 ± 4.3% to 79.2 ± 3.8%; p < .0001). Clinically significant cortical overhang (>1 mm), primarily in the posterior-lateral region, was present in 12.1% of cases, and varied by design, as expressed by the area of the tray overhanging the cortical boundary (min: 2.3 ± 6.7 mm. 2. ; max: 4.7 ± 7.9 mm. 2. ; p < .0001). The surgeons and the trainees also differed in terms of the incidence of sub-optimal tibial coverage (10.0% vs. 14.4%, p < 0.001), and cortical overhang (7.4% vs. 9.7%, p < 0.001). Discussion. 1. Malrotation, bony coverage and cortical overhang are all strongly influenced by the design of the tibial tray selected and the experience of the surgeon. 2. Compared to trainees, experienced surgeons tend to position tibial trays in more external rotation, and with less concern for reduced bony coverage and cortical overhang than trainees. 3. This study supports the hypothesis that improvements in the outcome and reliability of TKR may be achieved through attention to implant design

Introduction: The ten-year survivorship of Oxford Unicompartmental Knee Arthroplasty (OUKA) has ranged from 98% in the hands of the developers to only 82–90% in reports from independent centers and national registries. This study was performed to investigate the effects of surgeon training and correct patient selection on the expected outcome of this procedure. Methods: We created a computer-simulated joint registry consisting of 20 surgeons who performed OUKA on 1,000 patients. Mathematical models of the patient and surgeon populations and corresponding hazard functions were formulated using data from the Swedish and Australian joint registries. The long-term survivorship of UKA was assumed to average 94% at 10 years and was modeled as the product of hazard functions quantifying risk factors under the surgeon’s control, risk factors presented by the patient, and the inherent revision risk of the procedure. We performed four simulations looking at the effect of surgeon training by pairing surgeons and patients based on surgeon experience and patient risk factors. Results: When experienced surgeons (> 40 cases) performed OUKA on low risk patients (bottom quintile), the revision rate dropped from 6.0% to 4.5%. The same surgeons had a revision rate of 7.5% when assigned to the highest risk patient group (top quintile). Conversely, when the least experienced surgeons (< 10 cases) selected the least fit patients, the revision rate increased from 6% to 8.25%. However, when these surgeons were assigned to the lowest risk group, only 5.25% of patients were revised. Taken simultaneously, these results indicate that the overall revision rate of this procedure can vary between 4.5% to 8.25%, depending upon the experience of the surgeon and the patients selected. Conclusions:. Mathematical models of patients and surgeons can be built using joint registry data. These models can then be used in a computer simulation yielding results comparable to what has been reported in the literature. The outcome of Oxford UKA is primarily determined by the skill of the surgeon in selecting suitable patients rather than operative experience. Attempts to expand indications for new procedures should be moderated by concerns that the favorable results from pioneering centers may be due to the judgment and experience of the developers as much as their technical skill in performing the procedure

Introduction: Although Hip Resurfacing Arthroplasty (HRA) has become a popular alternative to THR, the outcome of these procedures varies extensively between centres. This has been attributed to variations in patient selection, surgical experience, and patient volume. In this study we examine the effect of hospital volume on the outcome of hip resurfacing using a national database. Methods: We examined data collected by the Australian Joint Registry between September 1999 and December 2006 relating to 8945 hip resurfacing procedures performed in 196 hospitals. Survivorship of the implanted components was calculated with revision as the end-point. The cumulative rate of revision at 4 years was compared between hospitals as a function of the number of cases performed during the study period (< 25, 25–49, 50–100, > 100 procedures). Using the log-rank test, differences in the risk of revision, corrected for age and sex of patients, were compared for low (< 25 cases) vs. higher volume centres (> 25 cases). We also estimated the number of cases/year of each centre and examined its apparent impact on revision rate. Results: The majority (74%) of hospitals reporting performed less than 30 resurfacing procedures over the 7 year study period, with 64% of procedures performed at 16 “high volume” hospitals (> 100 cases), Overall, 249 of the 8945 resurfacing procedures (2.9%) were performed for revision of the original components. At 4 years, the cumulative revision rate dropped from 5.8% for hospitals performing less than 50 cases to 4.7% (50–99 cases) and 2.7% (> 100 cases) for larger volume centres. When adjusted for differences in patient age and sex, the risk of revision was 66% higher in hospitals performing < 25 cases. Based on the available data, the gap in revision rate between high and low volume centres is reduced by 50% once a surgeon’s operative volume exceeds 6 cases per year. On average, this corresponds to a learning curve of approximately 5 cases. Conclusions: In this study, hospital volume is primarily a reflection of the operative experience of individual surgeons. Our results show that the outcome of hip resurfacing is strongly dependent on the experience of the surgeon and hospital performing the procedure. Even when adjusted for age and sex of the patients, the risk of revision increased by 66% when cases were performed at low volume centres. This supports the need for increased training of surgeons before undertaking hip resurfacing