Purpose
To compare postoperative pain and early recovery after hip arthroscopy with and without
a perineal post for joint distraction.
Methods
We retrospectively reviewed a consecutive series of patients who underwent hip arthroscopy
before and after the adoption of a postless technique. Patients who underwent concurrent
periacetabular or femoral osteotomy were excluded. Demographic information, procedure
variables, and visual analog scale (VAS) pain scores were recorded. Analgesic medications
given were converted to morphine milligram equivalents (MME) for comparison. Uni-
and multivariate analyses were conducted to compare total MME, postoperative pain,
and time to discharge between groups.
Results
One hundred patients were in each group. The overall age (mean ± standard deviation)
was 26.5 ± 9.9 years (Post [P]: 57 females; No Post [NP]: 68 females). Total operative
time (P 100.4 ± 17.9 minutes vs NP 89.1 ± 25.5 minutes, P = .0004), traction time (P 45.8 ± 10.3 minutes vs NP 40.9 ± 11.1 minutes, P = .0017), and operating room time (P 148.8 ± 19.3 minutes vs NP 137.3 ± 25.8 minutes,
P = .0005) were found to be shorter in the NP group. Total MME, and final VAS pain
scores in the PACU were similar between both groups (MME, P = .1620; VAS, P = .2139). Time to discharge was significantly shorter in the NP group (P 207.2 ±
58.8 vs NP 167.5 ± 47.9, P < .0001). Patient age (≥25 years) (65.2 ± 18.1 vs 59.8 ± 15.7 [MME], P = .0269) and elevated body mass index (≥25) (65.1 ± 17.1 vs 59.3 ± 16.4 [MME], P = .0164) were factors associated with greater total MME consumption. Female sex was
associated with higher postoperative VAS pain scores (FM 4.1 ± 1.6 vs M 3.4 ± 1.8
P = .0027).
Conclusions
Adoption of the postless technique did not result in prolonged operating room or operative
time. Overall, both groups had similar postoperative pain, however, the time from
surgery to hospital discharge was shorter in the postless group.
Level of Evidence
III, retrospective comparison study.
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 accessOne-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 ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial.BMJ. 2019; 364: l185
- The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement.Br J Sports Med. 2016; 50: 1169-1176
- Hip arthroscopy surgical volume trends and 30-day postoperative complications.Arthroscopy. 2016; 32: 1286-1292
- Surgical trends in arthroscopic hip surgery using a large national database.Arthroscopy. 2018; 34: 1825-1830
- Trends in hip arthroscopy utilization in the United States.J Arthroplasty. 2013; 28: 140-143
- Trends and demographics in hip arthroscopy in the United States.Arthroscopy. 2013; 29: 661-665
- Trends in hip arthroscopy.J Bone Joint Surg Am. 2012; 94: e23
- Trends in hip arthroscopic labral repair: An American Board of Orthopaedic Surgery Database study.Arthroscopy. 2019; 35: 1413-1419
- Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.Arthroscopy. 2013; 29: 589-595
- Complications in hip arthroscopy: A systematic review and strategies for prevention.Sports Med Arthrosc Rev. 2015; 23: 187-193
- Pudendal nerve injury is a relatively common but transient complication of hip arthroscopy.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 969-975
- Safety measures in hip arthroscopy and their efficacy in minimizing complications: A systematic review of the evidence.Arthroscopy. 2014; 30: 1342-1348
- Complications of hip arthroscopy in children and adolescents.J Pediatr Orthop. 2011; 31: 227-231
- Traction-related problems after hip arthroscopy.J Hip Preserv Surg. 2017; 4: 54-59
- Hip arthroscopy without a perineal post: A safer technique for hip distraction.Arthroscopy. 2007; 23 (107.e101-103)
- Hip distraction without a perineal post: A prospective study of 1000 hip arthroscopy cases.Am J Sports Med. 2018; 46: 632-641
- Hip arthroscopy distraction without the use of a perineal post: Prospective study.Orthopedics. 2013; 36: e1-e5
- Effects of hip arthroscopy without a perineal post on venous blood flow, muscle damage, peripheral nerve conduction, and perineal injury: A prospective study.Am J Sports Med. 2019; 47: 1931-1938
- Achieving post-free distraction in hip arthroscopy with a pink pad patient positioning device using standard hip distraction tables.Arthrosc Tech. 2019; 8: e363-e368
- Analyzing Opioid Prescription Data and Oral Milligram Morphine Equivalents (MME).(Accessed August 1, 2020)
Article Info
Publication History
Published online: March 31, 2021
Accepted:
March 17,
2021
Received:
September 30,
2020
Footnotes
See commentary on page 2846
The authors report the following potential conflicts of interest or sources of funding: M.C.W. reports other from Biomet, outside the submitted work. R.W.W. reports other from Arthroscopy, the American Journal of Sports Medicine, the American Orthopaedic Society for Sports Medicine , and CONMED Linvatec; and nonfinancial support from Smith & Nephew, outside the submitted work. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
