Arthroscopic Treatment: Principles of Hip Distraction

Abstract

Hip arthroscopy has immensely progressed over the past 10 years. The number of procedures performed and the complexity of the operations have also greatly increased. The increase in the complexity of the procedures has led to longer distraction times and steeper learning curves. Distraction times on traction tables of over 90 min have been reported to provoke feared neurologic complications, as well as perineal skin lesions. Cautious distraction techniques on traction tables and knowledge of these complications are essential for safer procedures. Pin (skeletal) hip distraction is a variant of hip distraction that avoids using a traction table. This technique uses acetabular and femoral Schanz screws to selectively distract the femoroacetabular joint and avoid totally neurologic complications and perineal skin lesions. It has been in use since the year 2000 and has been very successful in hip arthroscopy without neurologic complications or perineal skin lesions in over 3000 cases for traction times up to 210 min. It is a secure tool in the steep learning curve of complex hip arthroscopies and permits teaching young surgeons hip arthroscopy without the time limits of traction tables.