Hip arthroscopy (HA) is usually performed with a padded post on the perineum to apply traction to distract the hip joint. This correlates to genital and neurological pressure related complications such as pudendal and sciatic nerve neurapraxia. Duration of traction, type, shape and placement of the perineal post are key risk factors. Pudendal neurapraxia is usually experienced by men like perineal pain and hypoesthesia of the genitals. Women feel hypoesthesia of the perineum and labia. Sexual disorders are often associated such as erectile and ejaculatory disturbances and hypoorgasmia. Some complications could be permanent and very disabling. This is the reason why last studies focused about post-less traction systems in order to avoid perineum pressure related disfunctions. Four post-less techniques have been described in literature: Trendelenburg only, Tutankhamun technique, shape conforming foam pad and a combined Trendelenburg and friction pad system. The goal is to create enough resistance between the patient’s body and the bed to allow for successful hip distraction only through gravity force and friction. Postless techniques have other complications which are usually related to Trendelenburg position and that can be avoided if surgery lasts <2 hours. Moreover, several studies reported promising results concerning level of distraction and mean distraction force both comparable to the standard traction post technique. Post-less techniques offer the possibility to prevent perineal post complications and they guarantee enough distraction of the articulation to perform the surgery. A proper and careful technique should be used to avoid patient’s fall from the operating table. Patients’ characteristics and surgeon’s preferences must guide the choice of the suitable technique, waiting for more evidences.
Postless-technique in HIP arthroscopy
Aprato A.;Bonera M.;Olivero M.;Parisi G.;Masse A.
2021-01-01
Abstract
Hip arthroscopy (HA) is usually performed with a padded post on the perineum to apply traction to distract the hip joint. This correlates to genital and neurological pressure related complications such as pudendal and sciatic nerve neurapraxia. Duration of traction, type, shape and placement of the perineal post are key risk factors. Pudendal neurapraxia is usually experienced by men like perineal pain and hypoesthesia of the genitals. Women feel hypoesthesia of the perineum and labia. Sexual disorders are often associated such as erectile and ejaculatory disturbances and hypoorgasmia. Some complications could be permanent and very disabling. This is the reason why last studies focused about post-less traction systems in order to avoid perineum pressure related disfunctions. Four post-less techniques have been described in literature: Trendelenburg only, Tutankhamun technique, shape conforming foam pad and a combined Trendelenburg and friction pad system. The goal is to create enough resistance between the patient’s body and the bed to allow for successful hip distraction only through gravity force and friction. Postless techniques have other complications which are usually related to Trendelenburg position and that can be avoided if surgery lasts <2 hours. Moreover, several studies reported promising results concerning level of distraction and mean distraction force both comparable to the standard traction post technique. Post-less techniques offer the possibility to prevent perineal post complications and they guarantee enough distraction of the articulation to perform the surgery. A proper and careful technique should be used to avoid patient’s fall from the operating table. Patients’ characteristics and surgeon’s preferences must guide the choice of the suitable technique, waiting for more evidences.
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