The Hip Arthroscopy Post-less Procedure Impingement (HAPPI) Technique: Achieving Distraction With Standard Hip Tables at Zero Additional Cost

Jimenez, Megan Lisset; Haneda, Masahiko; Pascual‐Garrido, Cecilia

doi:10.1016/j.eats.2020.07.012

Cited by 11 publications

(14 citation statements)

References 8 publications

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“…These included use of a specialized hip distraction table with the patient in the Trendelenburg position (as in our study), the yoga mat technique, 9 the Tutankhamun technique, 8 the beanbag technique, 7 and the hip arthroscopy postless procedure impingement technique. 5 Thus, there are multiple ways of performing postless hip arthroscopy, although further studies are warranted to confirm the safety of the other techniques not used in the present study.…”

Section: Discussionmentioning

confidence: 74%

A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post

et al. 2022

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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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Section: Discussionmentioning

confidence: 74%

A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post

et al. 2022

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“…However, a recent systematic review found that multiple low-cost, semireproducible techniques exist for postless patient positioning without using a specifically designed, researched, and tested surgical bed and setup. 4 , 8 , 13 , 16 , 17 There are potential disadvantages of postless hip arthroscopy techniques that place the patient in the Trendelenburg position, such as the potential for abdominal fluid extravasation. However, the use of commercially available products in conjunction with these techniques allows for increased friction between the patient and the operating table, such that Trendelenburg positioning can be minimized and in some cases eliminated.…”

Section: Discussionmentioning

confidence: 99%

“… 4 These include use of a specialized hip distraction table with the patient in the Trendelenburg position, 11 , 20 the yoga mat technique, 17 the Tutankhamun technique, 16 the Beanbag technique, 13 and the hip arthroscopy postless procedure impingement technique. 8 Although a multitude of postless techniques have recently been published, it is unclear what proportion of hip arthroscopy surgeons are currently performing postless hip arthroscopy, which specific postless techniques are being used most commonly, and the perceived rate of perineal complications based on the various setup techniques used today. The purpose of this study was to assess the current international trends in the use of postless hip arthroscopy among hip preservation specialists.…”

mentioning

confidence: 99%

Current Trends in the Use of Postless Hip Arthroscopy: A Survey of the International Society for Hip Arthroscopy Membership

Kraeutler

Fasulo

Harris

et al. 2022

Orthopaedic Journal of Sports Medicine

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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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“…Jimenez et al. 10 conclude that postless surgery has become a popular method of performing HA and that although various techniques exist for achieving traction without a post, the majority require special beds and special equipment. Their technique can be performed with any hip traction table, at zero additional cost, and with the patient leveled before procedure starts.…”

Section: Discussionmentioning

confidence: 99%

The Yoga Mat Technique in Postless Hip Arthroscopy

Salas¹,

Mendez-Perez²,

Mazek³

et al. 2021

Arthroscopy Techniques

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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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The Hip Arthroscopy Post-less Procedure Impingement (HAPPI) Technique: Achieving Distraction With Standard Hip Tables at Zero Additional Cost

Cited by 11 publications

References 8 publications

A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post

A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post

Current Trends in the Use of Postless Hip Arthroscopy: A Survey of the International Society for Hip Arthroscopy Membership

The Yoga Mat Technique in Postless Hip Arthroscopy

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