The Effect of Traction Force and Hip Abduction Angle on Pudendal Nerve Compression in Hip Arthroscopy: A Cadaveric Model

Kocaoğlu, Hakan; Başarır, Kerem; Akmeşe, Ramazan; Kaya, Yasemın; Sindel, Muzaffer; Oğuz, Nurettin; Bínnet, Mehmet S.

doi:10.1016/j.arthro.2015.03.040

Cited by 20 publications

(9 citation statements)

References 21 publications

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“…Factors other than the amount of traction force might be of importance, as the position and the shape of the perineal post, anatomical differences and the position of the joint. 13 Hip arthroscopy performed without a perineal post might be promising in preventing the occurrence of nerve damage, 14 as described by Mei-ho et al 15 A major limitation of our study is that only patients with a body length up to 1.74 m could be included. The average height of the Dutch population of 20 years of age in 2016 was 1.74 m for women and 1.81 m for men.…”

Section: Discussionmentioning

confidence: 99%

Traction force for peroperative hip dislocation in hip arthroscopy

et al. 2019

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Objectives: Traction force widens the joint space during hip arthroscopy. It is unclear how much the traction force varies and if it is related to the joint space widening. Main goal of our study was to measure the amount of force needed to widen the hip joint. Second goal was to study the relation between this force and the amount of joint space widening. Methods: Traction force was measured in 27 patients (of whom 24 female, mean age 41) during arthroscopy. Measurements were performed before the procedure, after vacuum seal release and after capsulotomy. Joint space widening was measured with fluoroscopy and was calibrated. Friedman and Wilcoxon tests were used to measure differences in traction. The Spearman’s rho correlation coefficient was used to identify a correlation in traction force and joint space widening. Regression analyses were used to identify relations between age, body mass index (BMI), hip degeneration and traction force. Results: The median traction force before arthroscopy was 714 N, lowered to 520 N after vacuum seal release and to 473 N after capsulotomy ( p < 0.001). Median joint space widening was 8.8 mm. Spearmans’ rho correlation between traction force and joint space widening was ‒0.13. Discussion: Median traction force of 714 N resulted in 8.8 mm of joint space widening. This traction force was significantly lowered by 200 N after release of the vacuum seal of the hip and 250 N after additional capsulotomy without loss of joint space narrowing. No significant relation was identified for age, BMI or progression of the Kellgren-Lawrence classification for hip degeneration and traction force. Netherlands Trial Registry number 8610

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Section: Discussionmentioning

confidence: 99%

Traction force for peroperative hip dislocation in hip arthroscopy

et al. 2019

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“…For example, a cadaveric model has demonstrated that hip flexion up to 45° and increasing traction up to 40 kg increases pudendal nerve compression. 21 …”

Section: Discussionmentioning

confidence: 99%

“In-Round” Labral Repair After Acetabular Recession Using Intermittent Traction

Skelley

Conaway

Martin

2017

Arthroscopy Techniques

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The prevalence of hip arthroscopy has increased exponentially with the advent of arthroscopic labral repair techniques for femoroacetabular impingement. The goal of arthroscopic labral repair is to re-create the anatomic suction seal of the labrum against the femoral head. This important anatomic relationship has been demonstrated in several biomechanical studies. Performing the acetabular recession and evaluating the congruity of labral repairs during surgery is difficult with the application of traction distracting the femoral head from the chondrolabral junction. Additionally, prolonged traction risks nerve injury during hip arthroscopy. The purpose of this technique article is to describe a method of using traction only for central compartment work, and releasing the traction to allow the femoral head to reduce the labrum to its anatomic position for acetabular recession, anchor placement, and suture fixation. In this manner, the presented technique prevents an “out-of-round” or everted repair. This technique re-creates the native anatomy and biomechanics of the hip after acetabular recession and labral repair while decreasing traction time.

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“…28,29 In both studies' sham groups, patients are undergoing surgery with a perineal posteassisted distraction technique with risks of temporary and/or permanent pudendal neuralgia; scrotal, labial, and/or vaginal necrosis; genitalia injury; sex organ damage; sexual dysfunction; and urologic dysfunction at rates of up to 25%. [30][31][32][33] Portal placement (lateral femoral cutaneous nerve injury risk of up to 15%) and joint entry alone may cause iatrogenic injury (irreversible injury to articular cartilage and/or labrum). 34,35 In the sham group in one of the aforementioned studies, an interportal capsulotomy is performed but not repaired, leaving the hip at risk of postoperative instability and pain, as well as yielding a significantly increased risk of revision owing to microinstability (or even subluxation or dislocation).…”

Section: Author Reply To "Placebomentioning

confidence: 99%