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Salas AP, Mazek J, María AC, Taffinder DS, Velasco-Vazquez H. Hip Arthroscopy in Adolescents Through an Extra-Capsular Approach. Arthrosc Tech 2023; 12:e867-e871. [PMID: 37424655 PMCID: PMC10323734 DOI: 10.1016/j.eats.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
Hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tears is the gold standard in the adult and adolescent population, as we all know the most common surgical approach to the hip is entering the central compartment with fluoroscopy and with continuous distraction. A periportal capsulotomy in traction must be done to have visibility and instrument maneuverability. These maneuvers avoid scuffing the femoral head cartilage. In adolescents, extreme care must be taken in hip distraction, as the force used can cause iatrogenic neurovascular lesions, avascular necrosis, and lacerations of the genitals and foot/ankle. Experienced surgeons around the world have developed an extracapsular approach to the hip with smaller capsulotomies with a low complication rate. This approach to the hip has brought attention in the adolescent population because it is more secure and simple. Less force of distraction is needed because the capsulotomy is done first. This surgical technique allows observation of the cam morphology while entering to the hip without distraction. We describe an extracapsular approach as an option to treat femoral acetabular impingement syndrome and labral tears in the pediatric and adolescent population.
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Affiliation(s)
- Antonio Porthos Salas
- Address correspondence to Antonio Porthos Salas, M.D., Hip Arthroscopy Mexico, San Pedro Garza Garcia, Nuevo Leon, 66275, Mexico.
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Kraeutler MJ, Fasulo SM, Dávila Castrodad IM, Mei-Dan O, Scillia AJ. A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post. Am J Sports Med 2023; 51:155-159. [PMID: 36343362 DOI: 10.1177/03635465221130768] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies have demonstrated various groin-related nerve and soft tissue complications in patients undergoing hip arthroscopy with a perineal post. PURPOSE To prospectively compare groin-related nerve and soft tissue complications between patients undergoing hip arthroscopy with and without the use of a perineal post. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective single-surgeon cohort study was performed on all patients undergoing hip arthroscopy by the senior author between January 2020 and March 2022. A post-free hip distraction system was used at 1 center in which the senior author operates, and a system with a large padded perineal post was used at another surgical location. Patients completed a survey at the first postoperative visit (7-10 days) to determine if they had experienced any groin-related complications after surgery (groin numbness, sexual/urinary dysfunction, skin tears). Patients with a positive survey response repeated the survey at each follow-up visit (6 weeks, 3 months, 6 months) until the symptoms resolved. The rate and duration of groin-related complications were then compared between the groups. RESULTS A total of 87 patients were included in the study who underwent hip arthroscopy: 53 with a perineal post and 34 without. No differences were found between the post and postless groups in terms of age at surgery, sex, body mass index, or traction time. We found that 16 patients (30%) in the perineal post group experienced groin numbness versus 0 (0%) in the postless group (P < .0001). On average, groin numbness lasted 5 ± 3 days (mean ± SD) in the perineal post group. Three patients in the perineal post group experienced sexual dysfunction for a mean 7 days, as compared with none in the postless group. Seventeen patients (32%) in the perineal post group experienced foot numbness versus 4 (12%) in the postless group (P = .04). One patient in the perineal post group reported a superficial skin tear. CONCLUSION Postless hip arthroscopy resulted in no risk of groin-related complications as compared with traditional hip arthroscopy with a perineal post.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Sydney M Fasulo
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Iciar M Dávila Castrodad
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Omer Mei-Dan
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, USA.,Academy Orthopaedics, Wayne, New Jersey, USA
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Kraeutler MJ, Fasulo SM, Harris JD, Mei-Dan O, Scillia AJ. Current Trends in the Use of Postless Hip Arthroscopy: A Survey of the International Society for Hip Arthroscopy Membership. Orthop J Sports Med 2022; 10:23259671221143353. [PMID: 36582932 PMCID: PMC9793031 DOI: 10.1177/23259671221143353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies have demonstrated the risks of pudendal nerve and/or soft tissue complications due to the use of a perineal post during hip arthroscopy. Recently, various postless hip arthroscopy techniques have been described in the literature. Purpose To assess the current international trends in the use of postless hip arthroscopy among hip preservation specialists. Study Design Cross-sectional study. Methods An anonymous 11-item survey was sent by email to all members of the International Society for Hip Arthroscopy (ISHA) in January 2022. Surgeons were asked various questions regarding their current use of post-assisted or postless hip arthroscopy, if they had changed their setup technique during their career and the reason for that change, and their perceived rate of pudendal nerve and/or perineal soft tissue injuries using their current technique. Descriptive statistics were used to report the results of each question. The Student t test was used to compare the number of years in practice between post-assisted and postless users. Fisher exact tests were performed to compare categorical rates of pudendal nerve and soft tissue complications between post-assisted and postless users. Results A total of 126 surveys were completed from 431 ISHA members (29.2%). Sixty-one percent of the surgeons currently use a perineal post, while 33% use a postless technique. Seventy-five percent of the perineal post users and 98% of the postless users self-reported a rate of pudendal nerve and/or soft tissue injury of <1% (P = .015). Among 41 respondents who indicated changing their technique at some point, 59% reported doing so because of pudendal nerve and/or soft tissue complications. Among surgeons who switched from a perineal post to a postless setup, 71% indicated they have noticed a decrease in the rate of pudendal nerve and/or soft tissue complications. Conclusion Although use of a perineal post is still a more common setup technique among hip arthroscopists, approximately one-third of surgeons use a postless technique. Surgeons who have switched to a postless technique often did so because of perineal complications, with the majority noticing a subjective decrease in these complications with the use of postless hip arthroscopy.
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Affiliation(s)
- Matthew J. Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA.,Matthew J. Kraeutler, MD, Department of Orthopedics & Sports
Medicine, Houston Methodist Hospital, 6445 Main St, Suite 2300, Houston, TX
77030, USA ()
| | - Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical
Center, Paterson, New Jersey, USA
| | - Joshua D. Harris
- Department of Orthopedics & Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical
Center, Paterson, New Jersey, USA.,Academy Orthopaedics, Wayne, New Jersey, USA
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Decilveo AP, Kraeutler MJ, Dhillon J, Harris JD, Fasulo SM, Mei-Dan O, Scillia AJ. Postless Arthroscopic Hip Preservation Can be Adequately Performed Using Published Techniques. Arthrosc Sports Med Rehabil 2022; 5:e273-e280. [PMID: 36866293 PMCID: PMC9971859 DOI: 10.1016/j.asmr.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To identify and evaluate techniques used for postless hip arthroscopy. Methods A narrative review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify surgical technique articles or clinical studies describing techniques for the use of postless hip arthroscopy. Specific items sought for analysis included hip arthroscopy for femoroacetabular impingement including cam or pincer-type lesions, surgical time, traction time, traction force, bed Trendelenburg angle, intraoperative techniques, and postoperative outcomes, including complications. Exclusion criteria included any postless techniques used for open hip surgeries such as periacetabular osteotomy, sports hernia, peritrochanteric work, gluteus medius repair, ischiofemoral impingement, hamstring repair, or need for intraoperative conversion from postless to posted technique. Results Ten studies (1 Level III, 3 Level IV, 6 Level V), published from 2007 to 2021, were analyzed (1,341 hips, 51.5% male, mean age ranged from 16.0 to 66.0 years). In 4 studies, Trendelenburg position with a foam pad (The Pink Pad; Xodus Medical, Inc.) was used at 5 to 20°. Six of 10 studies contained no clinical results. The average traction force and time ranged from 65.0 to 88 pounds and 31.0 to 73.5 minutes, respectively. The remaining studies used the yoga mat technique, the Tutankhamun technique, the beanbag technique, and the Hip Arthroscopy Post-less Procedure Impingement technique. There was only one incident of pudendal neurapraxia, which resolved spontaneously at 6 weeks without complication. Sufficient distraction was able to be obtained using postless traction in all cases. Conclusions Postless hip arthroscopy may adequately be performed with a variety of techniques. Obtaining adequate traction and countertraction may be achieved through these postless methods. Clinical Relevance Given the potential serious complications that may result from use of a perineal post, it is important for surgeons to be aware of postless techniques that may be used effectively for hip arthroscopy.
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Affiliation(s)
- Alexander P. Decilveo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey
| | - Matthew J. Kraeutler
- Houston Methodist Hospital, Houston, Texas,Address correspondence to Matthew J. Kraeutler, M.D., Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main St., Suite 2300, Houston, TX 77030.
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | | | - Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey
| | - Omer Mei-Dan
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey,Academy Orthopaedics, Wayne, New Jersey, U.S.A
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Salas AP, Mendez-Perez E, Mazek J, Velasco-Vazquez H, Castillo-Trevizo A. The Yoga Mat Technique in Postless Hip Arthroscopy. Arthrosc Tech 2021; 10:e1525-e1530. [PMID: 34258200 PMCID: PMC8252824 DOI: 10.1016/j.eats.2021.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/13/2021] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy for the treatment of femoroacetabular impingement syndrome with anti-sliding techniques and without the use of a perineal post to achieve hip distraction has increased greatly in the past 5 to 10 years. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, acetabular cartilage defects, loose bodies, ligamentum teres tears, and avascular necrosis of the hip. In hip distraction, counter-distraction is needed, and this is achieved with a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy worldwide use a perineal post, but iatrogenic pudendal nerve, genital lacerations, hematomas, and groin complications have been reported to occur. In Latin American countries, disposable hip pad devices are expensive, and not all the arthroscopic companies provide them. Our yoga mat technique provides enough countertraction to achieve adequate hip distraction. Labral repair, labral reconstruction, and decompression of femoroacetabular impingement syndrome have been achieved properly, reliably, and reproducibly, and no Trendelenburg position is needed. Postless hip arthroscopy is made simple, and positioning the patient is not difficult. Hip surgeons can adapt this technique to a fracture table, a hip distractor, and a standard operating room table.
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Affiliation(s)
- Antonio Porthos Salas
- Hip Arthroscopy Mexico, San Pedro Garza García, México,Address correspondence to Antonio Porthos Salas, M.D., Hip Arthroscopy Mexico, San Pedro Garza Garcia, Nuevo Leon, Mexico.
| | | | - Jacek Mazek
- Ortopedika Hospital Hip Unit, Warsaw, Poland
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Jimenez ML, Haneda M, Pascual-Garrido C. The Hip Arthroscopy Post-less Procedure Impingement (HAPPI) Technique: Achieving Distraction With Standard Hip Tables at Zero Additional Cost. Arthrosc Tech 2020; 9:e1697-e1701. [PMID: 33294328 PMCID: PMC7695574 DOI: 10.1016/j.eats.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/11/2020] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy is becoming a more common treatment for femoroacetabular impingement, labral tears, and a variety of other hip pathologies. Unlike arthroscopy of the shoulder and knee, hip arthroscopy requires a significant amount of traction to gain access into the joint. Historically, traction has been achieved with the use of a perineal post. The use of a perineal post in hip arthroscopy can cause several avoidable complications such as neuropraxias (i.e., the pudendal nerve), vaginal or scrotal injuries, and perineal skin injuries. Several articles have been proposed using post-less techniques to obtain hip traction, but many of these techniques are expensive and require the purchase of new equipment. The purpose of this Technical Note is to describe a post-less technique for hip arthroscopy, the HAPPI technique (hip arthroscopy post-less procedure impingement), which is more affordable and does not require the addition of any special equipment. In addition, we will review some pearls and pitfalls, as well as advantages and disadvantages of the proposed technique.
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Affiliation(s)
| | | | - Cecilia Pascual-Garrido
- Address correspondence to Cecilia Pascual-Garrido, M.D., Ph.D., Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St. Louis, MO 63110.
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Hagerty M, Skelley N. Hip Arthroscopy in a Baseball Catcher without the Use of a Perineal Post: A Crossover Case Report. CASE REPORTS IN ORTHOPEDIC RESEARCH 2020. [DOI: 10.1159/000509678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 17-year-old Caucasian male high school baseball catcher presented with bilateral hip and groin pain of insidious onset over a 4-year period. Following appropriate physical exam and radiographic testing, bilateral labral tears secondary to cam type femoroacetabular impingement was diagnosed. Arthroscopic corrective surgeries were performed 4 months apart by a single specialized sports medicine orthopedic surgeon. One hip arthroscopic procedure utilized a well-padded perineal traction post and was associated with neuropraxic complications during recovery. The second hip arthroscopic procedure was performed with the table in 15° of Trendelenburg for traction without a perineal traction post and no neuropraxia was noted during recovery. The patient reported that outcomes and postoperative radiographic studies were similar bilaterally; however, perineal nerve neuralgias with the second hip arthroscopy were not reported. While other studies have described the use of post-less traction for mitigation of perineal nerve compression during hip arthroscopic procedures, this crossover observational report is the first to the authors’ knowledge demonstrating both neuropraxia and lack of neuropraxia in a single patient undergoing the same procedure bilaterally where the only difference is the usage of perineal traction posts.
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Salas AP, Brizuela-Ventura M, Velasco-Vazquez H, Mazek J. The Outside-In Technique for Slipped Capital Femoral Epiphysis: A Safe and Reproducible Approach in Hip Arthroscopy. Arthrosc Tech 2020; 9:e493-e497. [PMID: 32368469 PMCID: PMC7189202 DOI: 10.1016/j.eats.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement syndrome caused by slipped capital femoral epiphysis (SCFE) can be successfully treated arthroscopically and with the minimally invasive, outside-in surgical technique. The advantages of the technique are that the residual cam-type deformity caused by the slippage can be corrected and reconstructed reliably and reproducibly before distracting the hip joint; and radiation with fluoroscopy is used for only definitive reduction and reconstruction, which is obtained with cannulated screws. In addition, this safe technique allows distraction of the hip after screw placement, without affecting the reconstruction, to address labral tears and chondrolabral delaminations caused by the impingement.
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Affiliation(s)
- Antonio Porthos Salas
- Hip Arthroscopy and Preservation Mexico, San Pedro Garza Garcia, Mexico
- Address correspondence to Antonio Porthos Salas, M.D., Hip Arthroscopy and Preservation Mexico, Hospital Angeles Valle Oriente, Montes Rocallosos 209, 66290 San Pedro Garza Garcia, Mexico.
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Brand JC, Rossi MJ, Lubowitz JH. Hip Arthroscopy Complications Are Rare, but There Is Room for Improvement. Arthroscopy 2019; 35:1297-1299. [PMID: 31054706 DOI: 10.1016/j.arthro.2019.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023]
Abstract
Complications are agonizing and leave feelings of inadequacy, insufficiency, or ineptitude. For these and other reasons, complications are not frequently reported in the literature. But reporting of complications is not only cathartic, it can be illuminating. Once out in the daylight, complications can be categorized, quantified, parsed, analyzed, and dissected with the scientific method to yield insight to enable us to prevent complications that we can avoid. Technical innovations have demonstrated ability to solve current problems. Standardizing the reporting of complications allows comparability between centers. Better data lead to better analysis and may decrease the complication rate. Recent investigations published in Arthroscopy and elsewhere have improved our understanding of hip arthroscopy complications, making the procedure safer, more effective, and of higher value.
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