Hip Joint Venting Decreases the Traction Force Required to Access the Central Compartment During Hip Arthroscopy

Increased Labral Height Is Associated With Greater Distractive Stability of the Hip

PURPOSE

To examine the relationship of labral height measured on magnetic resonance imaging and resistance to axial distraction in patients with cam-type femoroacetabular impingement (FAI) syndrome.

METHODS

Patients who underwent primary hip arthroscopy for FAI syndrome between March 2020 and August 2020 were enrolled in the study traction protocol. Before any operative instrumentation, fluoroscopic images were taken of the native hip joint at 12.5-lb intervals between 0 and 100 lbs of axial traction on a postless traction table. Distraction was calculated as the difference between the total joint space at each traction interval and the baseline joint space. Labral height was measured on magnetic resonance imaging sagittal reformats at approximately 1:30 on the acetabular clockface by a musculoskeletal fellowship-trained radiologist blinded to the traction data. Descriptive statistics, independent samples t tests, Pearson χ2 tests, and Fisher exact tests were utilized in analysis.

RESULTS

Forty-three hips in 42 patients were included. Labral height was <6 mm in 19 (44%) patients and ≥6 mm in 24 (56%) patients. No statistically significant differences in age, sex, body mass index, alpha angle, Tönnis grade, lateral center edge angle, Beighton score, or presence of labral tears were observed between patients with <6 and ≥6 mm of labral height (P > .05). A greater percentage of patients with a labral height <6 mm broke their suction seal relative to patients with a labral height of ≥6 mm at 62.5 lbs (42% vs 4%; P = .003) and 100 lbs (95% vs 67%; P = .027).

CONCLUSIONS

Anterosuperior labral height ≥6 mm is associated with increased resistance to axial distraction on an examination under anesthesia in patients undergoing primary hip arthroscopy for FAI syndrome.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Arthroscopic Management of Femoroacetabular Impingement: Current Concepts

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction, especially in young and active individuals, and it may require surgical management for associated labral tears and cartilage damage. The management of FAI has advanced radically over the last few years, and hip arthroscopy has gained a leading role. However, despite the increasing number of published research and technological advancements, a comprehensive systematic review summarising current evidence is still missing. Methods: All the clinical studies investigating the arthroscopic management of FAI were accessed. Only studies with a minimum of six months of follow-up were considered. The 2020 PRISMA guidelines were followed. In December 2024, PubMed, Web of Science, and Embase were accessed without time constraints. Results: The present systematic review included 258 clinical investigations (57,803 patients). The mean length of follow-up was 34.2 ± 22.7 months. The mean age was 34.7 ± 5.3, and the mean BMI was 25.1 ± 2.0 kg/m2. Conclusions: The present systematic review updates current evidence on patients who have undergone arthroscopic surgery for FAI, updating and discussing current progress in managing labral injuries and patient selection, emphasising outcomes and pitfalls. Progress in surgery and improvement in eligibility criteria, as well as current controversies and prospects, were also discussed.

Experimental assessment of pelvis slipping during postless traction for orthopaedic applications

BACKGROUND

The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles.

METHODS

Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model.

RESULTS

Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions.

CONCLUSIONS

Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburg position did not increase adhesion.