Advertisement

Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy

Published:February 22, 2021DOI:https://doi.org/10.1016/j.arthro.2021.02.015

      Purpose

      This study evaluates the effect of venting on distraction of the hip during arthroscopy on a post-free traction table for fixed traction forces ranging from 0 to 100 pounds (lbs).

      Methods

      Patients underwent surgery by the senior author (S.K.A.) between November 2018 and July 2019. Inclusion criteria were primary hip arthroscopy requiring central compartment access. Patients were positioned in 10-15° Trendelenburg on a post-free traction table. Prior to instrumentation, fluoroscopic images of the operated hip joint were taken at 25-lb intervals from 0 to 100 lbs of axial traction. Traction was released for 15 minutes. Venting with 20 mL of air was performed and fluoroscopic images were repeated at all traction intervals. Joint displacement was measured at all intervals. An unvented control group underwent the same axial traction protocol for comparison.

      Results

      Sixty-one consecutive patients underwent study protocol. Fifty-eight hips in 57 patients were included. Thirty-two (55.2%) were female; mean age was 31 ± 13 years and mean body mass index was 25.7 ± 6.2. Paired samples analysis demonstrated mean differences in distraction distance prior to and after venting of 0.27, 2.60, 4.09, 4.54, and 2.31 mm at 0, 25, 50, 75, and 100 lbs of traction, which were significant (P < .001) at all traction intervals. Significantly more vented hips distracted at least 10 mm at 25-100 lbs traction (P ≤ .001). An unvented control group showed no significant differences between the first and second traction application.

      Conclusions

      Venting prior to applying traction on a post-free traction table increases the distraction distance achieved for a given traction force at multiple levels of traction in comparison to the pre-vented state. Our results suggest venting the hip joint prior to the application of traction may serve to reduce the maximal amount of traction required to safely instrument the hip arthroscopically.

      Level of Evidence

      IV, case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dienst M.
        • Seil R.
        • Gödde S.
        • et al.
        Effects of traction, distension, and joint position on distraction of the hip joint: An experimental study in cadavers.
        Arthroscopy. 2002; 18: 865-871
        • Mason J.B.
        • McCarthy J.C.
        • O’Donnell J.
        • et al.
        Hip arthroscopy: Surgical approach, positioning, and distraction.
        Clinical Orthop Relat Res. 2003; : 29-37
        • Devesa V.
        • Rovesti G.L.
        • Urrutia P.G.
        • San Roman F.
        • Rodriguez-Quiros J.
        Evaluation of a joint distractor to facilitate arthroscopy of the hip joint in dogs.
        J Small Anim Pract. 2014; 55: 603-608
        • Papavasiliou A.V.
        • Bardakos N.V.
        Complications of arthroscopic surgery of the hip.
        Bone Joint Res. 2012; 1: 131-144
        • Telleria J.J.M.
        • Safran M.R.
        • Gardi J.N.
        • Harris A.H.S.
        • Glick J.M.
        Risk of sciatic nerve traction injury during hip arthroscopy—Is it the amount or duration? An intraoperative nerve monitoring study.
        J Bone Joint Surg Am. 2012; 94: 2025-2032
        • Ellenrieder M.
        • Tischer T.
        • Bader R.
        • Kreuz P.C.
        • Mittelmeier W.
        Patient-specific factors influencing the traction forces in hip arthroscopy.
        Arch Orthop Trauma Surg. 2017; 137: 81-87
        • Nakano N.
        • Lisenda L.
        • Jones T.L.
        • Loveday D.T.
        • Khanduja V.
        Complications following arthroscopic surgery of the hip.
        Bone Joint J. 2017; 99-B: 1577-1583
        • Frandsen L.
        • Lund B.
        • Grønbech Nielsen T.
        • Lind M.
        Traction-related problems after hip arthroscopy.
        J Hip Preserv Surg. 2017; 4: hnw044
        • Kern M.J.
        • Murray R.S.
        • Sherman T.I.
        • Postma W.F.
        Incidence of nerve injury after hip arthroscopy.
        J Am Acad Orthop Surg. 2018; 26: 773-778
        • Philippon M.J.
        • Nepple J.J.
        • Campbell K.J.
        • et al.
        The hip fluid seal-Part I: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 722-729
        • Nepple J.J.
        • Philippon M.J.
        • Campbell K.J.
        • et al.
        The hip fluid seal—Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 730-736
        • Crawford M.J.
        • Dy C.J.
        • Alexander J.W.
        • et al.
        The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip.
        Clin Orthop Relat Res. 2007; 465: 16-22
        • Ito H.
        • Song Y.
        • Lindsey D.P.
        • Safran M.R.
        • Giori N.J.
        The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction.
        J Orthop Res. 2009; 27: 989-995
        • Röling M.A.
        • Mathijssen N.M.
        • Blom I.
        • Lagrand T.
        • Minderman D.
        • Bloem R.M.
        Traction force for peroperative hip dislocation in hip arthroscopy.
        Hip Int. 2020; 30: 333-338
        • Hodax J.D.
        • Flores S.E.
        • Cheung E.C.
        • Zhang A.L.
        Use of air arthrograms to aid in joint distraction during hip arthroscopic surgery decreases postoperative pain and opioid requirements.
        Orthop J Sports Med. 2019; 7 (2325967119837389)