Patient-Specific Parameters Associated With Traction in Primary and Revision Hip Arthroscopic Surgery

Kapron, Ashley L.; Karns, Michael R.; Aoki, Stephen K.; Adeyemi, Temitope F; Baillargeon, Elizabeth A; Hartley, Melissa K.; Todd, Jocelyn N.; Maak, Travis G.

doi:10.1177/2325967118807707

Cited by 16 publications

(19 citation statements)

References 27 publications

(34 reference statements)

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“…Gender was the only demographic variable that significantly affected the change in normalized distraction distance to traction force ratio for both venting and capsulotomy in multivariable regression analysis, with male sex predicting smaller increases in the ratio for both venting and capsulotomy. This finding is consistent with multiple previously published studies [ 4 , 16 ]. We hypothesize that the gender differences observed in this and other studies are related to females being more flexible in other myotendinous structures that cross the hip joint relative to male counterparts.…”

Section: Discussionsupporting

confidence: 94%

“…However, it should be again be noted that that the normalized distraction distance to axial traction force ratio is the inverse of the stiffness coefficient previously published by Kapron et al . [ 16 ] and that the use of a ratio that applies Hooke’s law is not necessarily inferior to assuming a fixed distraction distance in order to measure absolute reductions in traction force. Another important limitation of this study is that it tested the effects of both traction and capsulotomy in only one sequence—both procedures were performed sequentially once hips had achieved adequate distraction as determined by the attending surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Images were obtained using the same fluoroscopic imaging machine (OEC 9800 Mobile C-arm; GE Healthcare) with identical magnification (NORM) and collimation settings to minimize parallax phenomenon. The beam height of the fluoroscopy machine relative to the base of the surgical table was consistently maintained throughout image acquisition and between cases providing a reproducible, previously documented method of positioning to minimize imaging variability and parallax [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Normalized distraction distance was calculated according to previously published methodology [ 16 ]. Briefly, the pre-traction image was used to establish the neutral baseline, and a best fit circle was drawn around the femoral head and translated to the edge of the sourcil.…”

Section: Methodsmentioning

confidence: 99%

“…This ratio is the inverse of the stiffness coefficient previously described by Kapron et al . [ 16 ]. Both immediately before and immediately after each study intervention (application of traction, venting and capsulotomy), recordings were made from the instantaneous traction force curve.…”

Section: Methodsmentioning

confidence: 99%

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The effects of venting and capsulotomy on traction force and hip distraction in hip arthroscopy

O’Neill

Hadley

Adeyemi

et al. 2020

Journal of Hip Preservation Surgery

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This study evaluated the effects of venting and capsulotomy on the ratio of normalized distraction distance to traction force, correlating this trend with patient demographic factors. A ratio was chosen to capture the total effect of each intervention on the hip joint. During primary hip arthroscopy, continuous traction force was recorded, and fluoroscopic images were acquired to measure joint distraction before and after the application of traction, venting and interportal capsulotomy. Distraction–traction force ratios were compared using a one-sided paired t-test. A linear regression model was used to determine the relationship between age, sex and body mass index and pre- and post-intervention distraction–traction force ratios. Seventy-two adult patients and 73 hips were included. There was an increase in hip distraction with a decrease in traction force post-venting and capsulotomy (both P’s <0.001). Mean normalized distraction distance increased 1.5% of femoral head size after venting and an additional 2.2% of femoral head size after capsulotomy. Mean traction force decreased 2.2% (14.7 N) after venting and 2.3% (15.3 N) after capsulotomy. Female sex significantly correlated with larger differences in both pre- and post-venting capsulotomy ratios. Venting and capsulotomy both independently improve the ratio of normalized distraction distance to traction force when performed in vivo. However, the effect sizes of each intervention are small and of questionable clinical significance. Specifically, when adequate distraction for safe surgical hip access cannot be obtained despite application of significant traction force, venting and capsulotomy after the application of traction may not afford substantial improvement.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

The effects of venting and capsulotomy on traction force and hip distraction in hip arthroscopy

O’Neill

Hadley

Adeyemi

et al. 2020

Journal of Hip Preservation Surgery

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Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo identify factors associated with ease of hip distraction at the time of hip arthroscopy. MethodsA retrospective review of patients 17–50 years old undergoing hip arthroscopy with a single high‐volume hip arthroscopist was performed from 2014 to 2020. Demographics, clinical history, examination, and imaging findings were collected. Distractibility was quantified using turns of fine traction (1 turn = 4 mm axial distraction) with the patient paralyzed on a fracture table with a well‐padded perineal post Fine axial traction was applied after the patient’s perineum contacted the post. Demographic and clinical predictors of ease of distractibility were analyzed with simple linear regression models. Significant predictors were subsequently added to a multivariable linear regression model, estimating the effect of each variable. ResultsIn total, 453 patients were included, with an average age of 31.6 years (± 9.2) and 45.9% females. In univariate analysis, gender, race, BMI, range of motion, hyperextension–external rotation (HEER) test, the abduction–extension–external rotation test, and lateral center edge angle (LCEA) were associated with the number of fine traction turns required to distract the hip. On multivariable analysis, lower LCEA (p = 0.002), female gender (p < 0.001), and a positive HEER test (p = 0.045) were associated with decreased turns required for adequate hip distraction. ConclusionFemale gender, decreased LCEA, and a positive HEER test are associated with decreased axial traction required for adequate hip distraction at the time of hip arthroscopy. As ease of distractibility has been associated with hip microinstability, these findings may allow pre‐operative identification of hip instability patients and aid in pre‐operative counseling, risk stratification and capsular management planning. Level of evidenceIV. Clinical relevancePreoperative identification of risk factors for ease of hip distraction may raise pre‐surgical suspicion and, when coupled with other intraoperative findings, may aid in the diagnosis and management of hip microinstability.

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The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeHip microinstability has emerged as a contributor to young adult, non‐arthritic hip pain. There is a paucity of objective clinical data to identify patients with hip microinstability and guide surgical treatment. The purpose of this study was to identify the degree of distractibility in patients with and without microinstability undergoing hip arthroscopy. MethodsA single‐surgeon series of hip arthroscopies were retrospectively reviewed from 2014–2020. All procedures were performed with paralysis on a fracture table with a perineal post where 1 turn of fine traction equates to 4 mm of axial traction. Diagnosis was recorded as isolated instability, instability plus femoroacetabular impingement (FAI), and isolated FAI. Operative reports were reviewed to collect patient demographic data, number of turns of traction required for adequate distraction of the femoral head relative to the acetabulum (10 mm), and the presence of residual subluxation after initial traction was released. ResultsA total of 464 patients were identified, 26 (5.6%) with isolated microinstability, 183 (39.4%) with microinstability with FAI anatomy, and 255 (55.0%) with FAI. The concurrent diagnosis of microinstability was associated with decreased turns required to adequately distract the hip. Isolated microinstability patients required 6.9 turns (IQR 4.6–8.8) while those with instability plus FAI required 8.8 turns (IQR 6.5–11) and isolated FAI required 19.1 turns (IQR 15–22). Residual subluxation after removal of negative intra‐articular pressure but before performing the hip arthroscopy was more commonly associated with instability, occurring in 84.6% of isolated instability and 86.9% of instability plus FAI as compared with 29.8% in the isolated FAI cohort. ConclusionA diagnosis of hip microinstability, with or without features of FAI, is associated with decreased axial traction required to distract the hip. These data support the use of intra‐operative ease of distraction as a method of identifying patients with hip microinstability. Level of evidenceLevel III.

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Patient-Specific Parameters Associated With Traction in Primary and Revision Hip Arthroscopic Surgery

Cited by 16 publications

References 27 publications

The effects of venting and capsulotomy on traction force and hip distraction in hip arthroscopy

The effects of venting and capsulotomy on traction force and hip distraction in hip arthroscopy

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

The diagnosis of hip microinstability is correlated with ease of intra-operative hip distraction

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