Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

Mei-Dan, Omer; Kraeutler, Matthew J.; Garabekyan, Tigran; Goodrich, Jesse A.; Young, David

doi:10.1177/0363546517741704

Cited by 76 publications

(86 citation statements)

References 40 publications

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“…All patients underwent hip arthroscopy under general anesthesia. Hip arthroscopy was performed without a perineal post, as described previously, 20 , 32 on a specially designed hip arthroscopy distraction apparatus in the standard supine and in an 11° to 15° Trendelenburg position to allow access to the affected hip. Additionally, fluid pressure utilized during the procedure was maintained at ≤30 mm Hg to reduce soft tissue fluid extravasation (20-25 mm Hg during central compartment work and 25 mm Hg in >95% of cases during peripheral compartment work, with <5% of cases at 25-30 mm Hg during peripheral compartment work).…”

Section: Methodsmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Despite the rapid growth in the use of hip arthroscopy, standardized data on postoperative pain scores and activity level are lacking. Purpose: To quantify narcotic consumption and use of the stationary bicycle in the early postoperative period after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: In this prospective case series, patients undergoing a primary hip arthroscopy procedure by a single surgeon were asked to fill out a daily survey for 9 days postoperatively. Patients were asked to report their pain level each day on a visual analog scale from 1 to 10, along with the amount of narcotic pain pills they used during those postoperative days (PODs). Narcotic usage was converted to a morphine-equivalent dosage (MED) for each patient. Patients were also instructed to cycle daily starting on the night of surgery for a minimum of 3 minutes twice per day and were asked to rate their pain as a percentage of their preoperative pain level and the number of minutes spent cycling on a stationary bicycle per day. Results: A total of 212 patients were enrolled in this study. Pain levels (POD1, 5.5; POD4, 3.8; POD9, 2.9; P < .0001) and the percentage of preoperative pain (POD1, 51.6%; POD4, 31.8%; POD9, 29.5%; P < .01) significantly decreased over the study period. The amount of narcotics used per day (reported in MED) also significantly decreased (POD1, 27.3; POD4, 22.3; POD9, 8.5; P < .0001). By POD4, 41% of patients had discontinued all narcotics, and by POD9, 65% of patients were completely off narcotic medication. Patients were able to significantly increase the number of minutes spent cycling each day (POD1, 7.6 minutes; POD4, 13.8 minutes; POD9, 19.0 minutes; P < .0001). Patients who received a preoperative narcotic prescription for the affected hip were significantly more likely to require an additional postoperative narcotic prescription ( P < .001). Conclusion: Patients can expect a rapid decrease in narcotic consumption along with a high degree of activity tolerance in the early postoperative period after hip arthroscopy.

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Section: Methodsmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…A study by Mei-Dan et al which reported on 309 hips operated on using this technique found that the mean Trendelenburg angle was 11° ± 2° and that the patient variables determining distraction force were sex, weight, and lateral center edge angle (LCEA). [14] Males, heavier individuals, and those with a high LCEA required a higher distraction force. Further studies of post-less HA use ordinary equipment to achieve distraction, while sustaining low costs, demonstrating increasing accessibility of this technique.…”

Section: Advances Alternatives To Perineal Postmentioning

confidence: 95%

Recent advances and future trends in hip arthroscopy

Zhang

Pettit

Kumar

et al. 2020

JASSM

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Hip arthroscopy (HA) is a well-established minimally invasive technique used to treat a wide range of conditions. Technological innovations have expanded the scope of HA and improved its outcomes. Several authors have described post-less arthroscopy to overcome the risk associated with the use of the perineal post for obtaining distraction of the hip joint. Instrument refinement has improved the efficacy of labral repair and reconstruction. Several treatment strategies are available for articular cartilage defects including ACI, MACI, and mosaicplasty, to name a few. Some authors have suggested that ligamentum teres reconstruction is helpful in young active patients with femoroacetabular impingement experiencing subluxation of the hip joint. The incorporation of new technology and patient-specific approaches represents a new way to improve HA outcomes. Virtual reality simulation training is the key to overcoming the steep learning curve associated with HA and to achieve high standards early in a surgeon’s career. Computer-based navigation surgery may be the key to accurately resecting the cam deformity and reducing the rate of revision surgery due to inaccurate resection at the index procedure. Assessment and optimization of the baseline psychological state and effective pre-habilitation may also improve outcome measures. Adequate stratification of the pathology and assessment of baseline patient characteristics influences the long-term outcome following the HA.

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“…All patients underwent hip arthroscopy without a perineal post [ 29 ] prior to PAO/DFO in order to address intra-articular hip pathology such as labral tears, chondral damage, cam lesions and/or LT tendinopathy. The osteotomy procedure was performed 7–14 days following arthroscopy.…”

Section: Methodsmentioning

confidence: 99%

Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis

Kraeutler

Garabekyan

Mei-Dan

2018

Journal of Hip Preservation Surgery

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There are currently no established guidelines for appropriate antithrombotic prophylaxis following periacetabular osteotomy (PAO) or derotational femoral osteotomy (DFO). The purpose of this study was to determine the incidence of clinical deep venous thrombosis (DVT) following PAO and/or DFO wherein a portable, mechanical device and low-dose aspirin were used postoperatively for DVT prophylaxis. Patients who had undergone staged hip arthroscopy and primary PAO and/or DFO were prospectively reviewed. Following PAO/DFO, patients were prophylactically treated for thromboembolic disease with a portable, mechanical compression device for 3 weeks and low-dose aspirin for 4 weeks. Patients were followed in clinic until 24 months postoperatively. During the study period, 145 hips (124 patients) underwent surgery (PAO: 109, DFO: 24, PAO + DFO: 12). Overall, the incidence of clinically apparent DVT was 0% in the study cohort. Average estimated blood loss during surgery was 601 mL and five cases required blood transfusions of 1 or 2 units. Ten patients were seen in the emergency room 10–20 days after surgery presenting with calf tenderness and DVT was ruled out in all cases with ultrasound. There were no postoperative bleeding or wound complications. A portable, mechanical compression device and low-dose aspirin effectively lessens the risk of DVT following staged hip arthroscopy and PAO/DFO without an increased risk of bleeding complications.

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Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

Cited by 76 publications

References 40 publications

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Recent advances and future trends in hip arthroscopy

Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis

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