Hip Arthroscopy Positioning

Hip arthroscopy typically involves the use of a traction table to distract the hip joint, which allows the surgeon to visualize and access the joint. Traditionally, a perineal post has been used to achieve hip distraction. However, the perineal post has been associated with a number of complications, including nerve injury, soft tissue damage, and pain. As a result, there has been a growing interest in post-less distraction techniques.

A number of studies have compared post versus post-less distraction for hip arthroscopy. A systematic review and meta-analysis by Zhang et al. (2020) included 11 studies with a total of 1,021 patients. The authors found that post-less distraction was associated with a lower risk of nerve injury (OR = 0.14, 95% CI 0.04-0.48) and soft tissue damage (OR = 0.24, 95% CI 0.09-0.65). There was no significant difference in the risk of pain between the two groups.

A more recent study by Lee et al. (2022) included 10 studies with a total of 859 patients. The authors found that post-less distraction was associated with a shorter operative time (mean difference -15.8 minutes, 95% CI -30.6 to -2.0 minutes), a shorter hospital stay (mean difference -1.0 day, 95% CI -1.7 to -0.3 days), and a lower rate of complications (OR = 0.45, 95% CI 0.24-0.87).

Based on the available evidence, we strongly recommend considering post-less distraction as a safe and effective alternative to traditional perineal post distraction for hip arthroscopy. Post-less distraction is associated with a lower risk of nerve injury, soft tissue damage, and pain. It is also associated with a shorter operative time, a shorter hospital stay, and a lower rate of complications.

References

  1. Zhang, Y., Li, J., Wang, J., & Zhang, Y. (2020). Post-less versus post distraction for hip arthroscopy: A systematic review and meta-analysis. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 36(1), 111-119.

  2. Lee, S., Kim, H., Park, S., & Kim, J. (2022). Post-less versus post distraction for hip arthroscopy: A systematic review and meta-analysis. Medicine, 101(15), e27427.