Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy

O’Neill, Dillon C.; Mortensen, Alexander J.; Tomasevich, Kelly M.; Ohlsen, Suzanna M.; Adeyemi, Temitope F; Maak, Travis G.; Aoki, Stephen K.

doi:10.1016/j.arthro.2021.02.015

Cited by 9 publications

(18 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent study of 309 hips, Mei-Dan et al 3 demonstrated that male sex, increased body mass index (BMI), and increased acetabular coverage (quantified by the lateral center edge angle) were associated with greater forces required to achieve joint distraction. Accordingly, O'Neill et al 2 demonstrated that there were no differences in patient sex or acetabular coverage between vented and control participants, though there was a small difference in BMI (0.7 kg/ m 2 ), that is unlikely to explain the magnitude of the study findings. In addition, there were no differences in the preoperative Beighton Score or anesthesia used between groups.…”

Section: Chicago Illinoismentioning

confidence: 68%

“…We congratulate O'Neill, Mortensen, Tomasevich, Ohlsen, Adeyemi, Maak, and Aoki on their recent contribution titled "Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy." 2 This study included 78 patients (58 vented, 20 controls) undergoing primary hip arthroscopy requiring access to the central compartment. Patients were positioned in 10 to 15 of Trendelenburg on a post-free traction table.…”

Section: See Related Article On Page 2164mentioning

confidence: 99%

See 1 more Smart Citation

Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications

Nho¹,

Alter²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Hip arthroscopy for the treatment of femoroacetabular impingement syndrome requires access to the central compartment of the hip, which is more easily obtained with hip distraction. However, surgeons must balance improved surgical access with the risks of postoperative complications. Hip joint venting describes the disruption of the suction seal by introducing a large-gauge needle into the joint space and injecting air or fluid into the joint. Joint venting performed before initiating axial traction may reduce the force required to obtain central compartment access while mitigating postoperative complications.

show abstract

Section: Chicago Illinoismentioning

confidence: 68%

Section: See Related Article On Page 2164mentioning

confidence: 99%

Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications

Nho¹,

Alter²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

show abstract

“…We must translate the bench to the bedside. Surgeons are finally starting to do this: O'Neill et al, 7,8 in 2 separate publications using a proprietary postless hip distraction system, have not only measured the strength of the seal, they have also provided recommendations for decreasing force of distraction. Personally, in my prospective database, I quantitatively measure and record several aspects of the seal and its breakage: after an air arthrogram, the force (Newtons; pounds of force) required to sufficiently distract the hip; the degrees of Trendelenburg of the bed; and the amount of femoral head distraction (millimeters).…”

Section: See Related Article On Page 352mentioning

confidence: 99%

Editorial Commentary: Hip Primary Labral Repair Versus Reconstruction: Equally Successful Outcomes Can Be Achieved Based on Proper Indications

Harris¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

One of the core principles of hip arthroscopy is preservation of the acetabular labrum. Compromise of the biomechanical function of the labrum underlies a significant symptom source in patients undergoing hip preservation surgery. As surgical techniques continue to improve and evolve beyond labral repair, increased use of advanced arthroscopic procedures like segmental and circumferential reconstruction shed further light on the optimal labral intervention. In the revision setting, labral deficiency warrants labral reconstruction or augmentation. Both segmental and circumferential techniques may significantly improve patient-reported outcomes. However, in the primary setting, controversy exists not necessarily in the surgical technique, but more in the indications to perform which specific labral intervention. Reasonable indications for primary labral reconstruction include a calcified or ossified labrum, irreparable labral tissue, and hypotrophy of the labrum (less than 2-3 mm) with a proven deficient suction seal without resistance to axial distraction. Short-term multicenter studies demonstrate similar success rates between primary labral reconstruction and repair using validated patient-report outcome scores. Mid-and long-term clinical and economic investigations comparing labral reconstruction and repair are needed to determine the role of primary reconstruction in modern arthroscopic hip preservation surgery.

show abstract

“…Joint distension with intra-articular injection of saline or air to break the hip fluid seal can significantly improve the distraction and decrease the traction force. 3,5,16,17 The CC-first technique may be the most popular access technique in hip arthroscopy. The main concern for this technique is the potential risk of iatrogenic damage to the labrum or cartilage during the first portal placement.…”

mentioning

confidence: 99%

“…Joint distension with intra-articular injection of saline or air to break the hip fluid seal can significantly improve the distraction and decrease the traction force. 3,5,16,17…”

mentioning

confidence: 99%

Distraction Gap Needed for Safe Central Compartment Access in Hip Arthroscopy

et al. 2023

View full text Add to dashboard Cite

Background: Sufficient distraction of the hip is the key to a safe central compartment (CC) approach in hip arthroscopy. However, an adequate distraction gap has not been scientifically identified. Purpose: To determine the sufficient amount of distraction that could predict a successful CC access as well as to identify the risk factors for a failed or difficult CC access. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent hip arthroscopy by a single surgeon between January 2018 and April 2019 were prospectively enrolled. We analyzed gaps of the hip on 4 C-arm fluoroscopic images: nondistraction, preoperative manual traction, preoperative maximal traction (without distension), and intraoperative maximal traction (at the end of CC procedures in a successful CC approach or after peripheral compartment procedures in a failed or difficult CC approach). A failed CC approach was defined as failure in introducing the anterolateral portal to the CC under arthroscopic control; a difficult CC approach was defined as the presence of an incomplete diagnostic round in the CC because of a small distraction. The amount of distraction was evaluated by the ratio of the distracted gap to the undistracted gap. Patients were classified into the successful CC access group (group 1) and the failed/difficult CC access group (group 2). The amount of distraction, demographic characteristics, and preoperative radiographic parameters were compared between the groups. Results: A total of 240 patients were included in this study. Group 1 consisted of 205 patients (113 males and 92 females; mean ± SD age, 34.5 ± 11.4 years), and group 2 consisted of 35 patients (27 males and 8 females; age, 32.5 ± 11.2 years). The preoperative joint space width was not significantly different between group 1 (mean ± SD, 3.89 ± 0.83 mm) and group 2 (3.68 ± 0.68 mm). The ratio of the amount of distraction at lateral gaps under all traction conditions was significantly greater in group 1 compared with group 2 (1.50 ± 0.54 vs 1.26 ± 0.35, respectively, under preoperative manual traction; 2.84 ± 0.76 vs 2.03 ± 0.63 under preoperative maximal traction; 3.36 ± 0.96 vs 2.50 ± 0.79 under intraoperative maximal traction). An increase of the lateral gap by >2.2 times ( P < .001) under preoperative maximal traction and by >2.7 times ( P < .001) under intraoperative maximal traction could predict successful CC access. Male sex (odds ratio [OR], 2.94; P = .017) and increased lateral center-edge angle (OR, 1.08 for every 1° increase; P = .004) were significant risk factors for failed/difficult CC access. Conclusions: An increase of the lateral gap by >2.2 times during an unsterile traction test without joint distension could predict successful CC access. Male sex and increased lateral center-edge angle were risk factors for a failed or difficult CC access.

show abstract

Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy

Cited by 9 publications

References 15 publications

Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications

Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications

Editorial Commentary: Hip Primary Labral Repair Versus Reconstruction: Equally Successful Outcomes Can Be Achieved Based on Proper Indications

Distraction Gap Needed for Safe Central Compartment Access in Hip Arthroscopy

Contact Info

Product

Resources

About