Hip Distraction with Perineal Post
The hip joint is a ball and socket joint and is surrounded by muscles, ligaments, and tendons. Traditionally, access to the hip joint for surgery was achieved by placing traction to the operative leg and perineal posts (wide-diameter post) in the groin region. This was necessary for the distraction of the joint and introducing surgical instruments to perform the surgery. Perineal posts apply pressure to the groin region and may cause:
- Skin complications
- Pudendal neuropraxia (temporary loss of nerve conduction)
- Damage to surrounding nerves
- Sexual disorders (both men and women)
- Necrosis of the surrounding tissue
- Vaginal tears (women)
Postless Hip Arthroscopy
Postless hip arthroscopy is a minimally-invasive surgical technique that does not involve the use of perineal posts. Surgery is performed by arthroscopy. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury and repair it.
Indications for Postless Hip Arthroscopy
Postless Hip arthroscopy is indicated for one or more of the following hip conditions:
- Torn hip cartilage that causes hip pain and immobility
- Torn labrum (fibrous cartilage ring that lines the acetabular socket)
- Bone spurs or extra bone growths caused by arthritis or an injury
- Inflamed synovium (lining of the joint) if you have inflammatory arthritis (partial synovectomy)
- Fractures or torn ligaments caused by trauma
Preparing for the Surgery
Talk to your doctor about the medicines you are taking prior to the procedure. Inform your doctor if you are allergic to any medicines or anesthesia. Do not eat or drink 6-8 hours prior to the surgery. Be prepared for an overnight stay at the hospital and arrange for someone to drive you home the next day.
Postless Hip Arthroscopy Procedure
The procedure is performed under general anesthesia and involves the following steps:
- You will lie on your back (supine position) on the operating table.
- Your body will be supported by a shape-conforming foam. Bony prominences of your foot may be padded.
- A narrow-padded post is used which may be placed about 10cm away from the perineum. The post is off-center and towards the operative side. This unique positioning achieves hip distraction necessary for the arthroscopic surgery. Non-operative limb positioning is maintained stress-free.
- Internal rotation of the limbs will be performed by your surgeon enabling the placement of the arthroscope in the hip joint.
- Traction techniques are used by your surgeon for safe insertion of the arthroscope.
- The arthroscopic surgery is performed on your hip depending on the type of hip problem.
Advantages of Postless Hip Arthroscopy
Since no pressure is applied to the perineum, damage to the nerves and the soft tissue is prevented.
Painkillers will be prescribed to manage pain. Your physical therapist will teach you to use a walker or crutches and may begin with light weight-bearing exercises. Specific exercises will be given to help you recover faster. You should regularly follow-up with your surgeon to ensure a successful outcome. You may return to normal activities after a few months with your surgeon’s approval.