Femoroacetabular impingement (FAI) is a common cause of hip pain in the young adult. Uncertainty regarding surgical indications, outcome assessment, management preferences and perceptions of the literature exist. We conducted a large international survey assessing the perceptions and demographics of orthopaedic surgeons regarding FAI. A survey was developed using previous literature, focus groups and a sample-to-redundancy strategy. The survey contained forty-six questions and was emailed to national orthopaedic associations and orthopaedic sports medicine societies for member responses. Members were contacted on multiple occasions to increase response rates. Nine hundred orthopaedic surgeons from twenty national and international organisations completed the survey. Surgeons responded across 6 continents, 58.2 % from developed nations with 35.4 % having sports fellowship training. North American and European surgeons reported significantly greater exposure to hip arthroscopy during residency and fellowships in comparison to international respondents (48.0% vs. 44.5% vs. 25.6% respectively; p<0.001). Surgeons performing a higher volume of FAI surgery (over 100 cases per year) were significantly more likely to have practiced for more than 20 years (OR 1.91; 95% CI 1.01 to 3.63), be practicing at an academic hospital (OR 2.25; 95% CI 1.22 to 4.15), and have formal arthroscopy training (OR 46.17; 95% CI 20.28 to 105.15). High volume surgeons were over two-fold more likely to practice in North America and Europe (OR 2.26; 95% CI: 1.08 to 4.72). The exponential rise in the diagnosis and surgical management for FAI appears to be driven largely by experienced surgeons in developed nations. Our analysis suggests that although FAI management is early in the innovation cycle we are at a tipping point towards wider uptake and utilisation. The results of this survey will help guide further research and study

Background. Surgical simulators allow learner-focussed skills training, in controllable and reproducible environments suitable for assessment. Aim. To research the face validity (extent to which the simulator resembles reality, determined subjectively by subjects), and construct validity, (ability to objectively differentiate between subjects with varying levels of arthroscopic experience) of a virtual reality arthroscopy simulator, to validate its effectiveness as an educational tool. Methods. Using the simulator insightArthroVR®, 37 subjects were required to perform diagnostic knee arthroscopy, palpate anatomical landmarks and complete questionnaires. The simulator recorded objective data to assess proficiency: time to complete tasks, roughness in instrument handling, and path length covered by the arthroscope and palpation probe. Results. The simulator succeeded in proving face validity: 86.4% participants agreed the simulator provided insight into arthroscopy. Training met the expectations of 91.3% and showed improvement in novices in simulated diagnostic arthroscopy in completion time (p-value=0.036), roughness (p-value=0.026), and path length covered by the arthroscope (p-value=0.008). Furthermore, the simulator was able to discriminate between experts, intermediates and novices, proving construct validity: time of completion (p-value=0.009), the path length covered by the arthroscope (p-value=0.02) and the probe (p-value=0.028). Conclusions. Results demonstrate the simulator succeeds in emulating real arthroscopy and can discriminate between subjects according to arthroscopic experience, proving face and construct validity. Further research on transfer of skills to the operating room needs to be done. With surgery constantly modernising and increasing time constraints with the EWTD, training must be efficient and assessable without compromising patient safety. Simulators could allow trainees earlier exposure to procedures, a wider range of pathologies in a compressed period, practice outside the OR, and an acceleration of the learning curve. This study has taken a step forward in validating a VR simulator and thus a step towards the future of simulation becoming an indispensable adjunct to surgical training