The Tutankhamun Technique in Hip Arthroscopy

Abstract

Hip arthroscopy has been increasing tremendously in the past decade and is a very common surgical procedure to repair femoroacetabular impingement. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, cartilage loose bodies, and ligamentum teres tears and to evaluate the condition of the femoral head and acetabular cartilage. To distract the hip, counterdistraction is needed, and this is achieved with placement of a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy use a perineal post, whereas others use beanbags to place the patient's body on the surgical table. Still others do not use a post at all but rather use gravity and a Trendelenburg position to achieve distraction. Our technique does not use a perineal post but instead uses heavy-duty tape over the patient's upper body, which is placed on a normal operating room table to distract the hip while entering the central compartment.

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

“…Although a perineal post is still frequently used for hip arthroscopy, various techniques have been described without the use of a post. 1,[5][6][7] In this Technical Note, we describe a post-less technique for hip arthroscopy using the Hip Positioning System Fig 6. (A) The bed is leveled out after appropriate traction is obtained and arthroscopy is started with conventional portals.…”

“…Although a perineal post is still frequently used for hip arthroscopy, various techniques have been described without the use of a post. 1 , 5 , 6 , 7 In this Technical Note, we describe a post-less technique for hip arthroscopy using the Hip Positioning System (Smith & Nephew), although the technique can be used with any bed. This technique only requires a safety strap (AliMed) and pink egg crate (Cardinal Health) or any type of soft-tissue padding.…”

“…Although traction is required for hip arthroscopy, the use of a perineal post can result in several complications, including neuropraxias, vaginal or scrotal injuries, and perineal skin injuries. 1 , 2 , 3 Multiple studies have demonstrated that the majority of neuropraxias related to hip arthroscopy affect the pudendal nerve. 2 , 3 , 4 In a prospective study performed by Kern et al., 4 the incidence of nerve injury was 13% (13 of 100 patients), with 9 of these patients presenting with a pudendal compression-type traction neuropraxia.…”

“…The main disadvantages of these systems include the high cost and varying patient positioning. 1 , 5 , 6 , 7 Some techniques require the patient to remain in Trendelenburg, whereas others limits anesthesia an adequate access to the upper extremities.…”

Recent advances and future trends in hip arthroscopy

“…[15] A novel hip arthroscopic technique named the "Tutankhamun Technique" was developed and trialed using standard duct tape to stabilize the upper body on a flat table while the leg is in traction, thereby achieving distraction of the hip joint. [16] The name reflects the binding of the hands and elbows over the patient's chest, resembling the Egyptian mummy. This forgoes the requirement of an adjustable table, however, limitations exist and the authors recommend performing a test traction measurement before operation, due to the risk of the patient sliding down the table.…”