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Post-less technique for hip distraction may be safe during hip arthroscopy
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Patients who underwent hip arthroscopy using the Trendelenburg position and a specially designed distraction setup experienced safe hip distraction with no groin-related soft tissue and nerve complications, according to results published in The American Journal of Sports Medicine.
Traditionally, hip arthroscopy is performed with a perineal post, according to study co-author Omer Mei-Dan, MD, which results in “various groin-related complications, including nerve neurapraxias, vaginal tears and scrotal necrosis.” As questions pertaining to urologic or sexual dysfunction are not included in most standard postoperative outcome measures, Mei-Dan said these problems are under-reported in the literature and can be “devastating for the typical hip arthroscopy patient who is young and sexually active.”
“Our study presents an alternative post-less technique for hip distraction by placing the patient in Trendelenburg on a specially designed distraction device, with no counterforce on the perineum,” Mei-Dan told Healio.com/Orthopedics. “This technique allows us to perform hip distraction in a safe and reproducible manner while completely eliminating groin-related soft tissue and nerve complications.”
Mei-Dan and colleagues analyzed the degrees of Trendelenburg and distraction force among 309 hips in 281 patients who underwent hip arthroscopy for hip pain. Researchers also collected demographic variables, hip pathology and lateral center edge angle for each case.
Results showed a mean Trendelenburg angle of approximately 11°, as well as a mean initial distraction force of approximately 90 pounds. By 30 minutes after traction initiation, researchers found the distraction force decreased to approximately 65 pounds. According to results, sex, weight and lateral center edge angle were the most important variables in determining initial force for this cohort.
Patients had no groin-related complications, including soft tissue or nerve-related complications. Results showed a rate of deep venous thrombosis of two in 1,000. – by Casey Tingle
Disclosures: Mei-Dan reports he has shares in MITA and receives royalties from and is a consultant for Stryker. Please see the full study for a list of all other authors’ relevant financial disclosures.
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