AANA Lab Course 905 - 2nd Annual Fellows Course-Postless Hip Arthroscopy-Joshua D. Harris, M.D.

Postless Hip Arthroscopy-Joshua D. Harris, M.D.

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This document, authored by Joshua Harris, MD, discusses the technique and benefits of postless hip arthroscopy, focusing on avoiding complications associated with the traditional use of a perineal post during hip procedures. <br /><br />Traditional hip arthroscopy often requires traction using a perineal post, which can cause soft tissue and nerve injuries in the perineal region, including damage to the scrotum, penis, labia, pudendal nerve, and others. Post-related complications are underreported but involve significant rates of postoperative numbness, with some patients experiencing symptoms lasting over two years.<br /><br />Postless hip arthroscopy offers several advantages. By eliminating the perineal post, it removes soft tissue and nerve compression, significantly reducing postoperative pain and opioid usage. It also allows for longer traction times necessary for advanced procedures such as labral reconstruction, protrusio treatment, ligamentum teres reconstruction, and synovial chondromatosis. This technique facilitates better training opportunities by lowering traction-related risks while teaching. It does not require the Trendelenburg position, accommodates patients of all heights (especially tall individuals), and tends to ease distraction in heavier or older patients. Additionally, there's increased range of motion for dynamic examination and minimal learning curve for surgeons transitioning to this method.<br /><br />Challenges include the need for additional operating room staff training and potential increased costs for equipment like pads or tables. Achieving distraction may be more difficult in lighter patients. There is also concern about stability and fall risk without a post, although this can occur even with posts. Friction between the patient's skin and the operating table may cause anterior pelvic tilt during traction.<br /><br />The postless technique setup involves a specially designed 2.5 cm thick pad customized to the surgical bed, with proper positioning of limbs and securement for safety. Overall, this method is safe, reduces common traction-associated complications, improves patient comfort, and requires no major changes to standard hip arthroscopy protocols.

Keywords

postless hip arthroscopy

perineal post complications

hip traction injuries

soft tissue and nerve compression

labral reconstruction

ligamentum teres reconstruction

synovial chondromatosis treatment

traction-related risks

operating room staff training

hip arthroscopy patient positioning