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

Background: Hip arthroscopy for femoroacetabular impingement (FAI) syndrome continues to gain popularity and indications for its use are expanding. Though low complication rates have previously been reported, there are iatrogenic complications specific to the use of the perineal post, such as pudendal nerve injuries, and possible pressure skin necrosis that warrant concern in the healthy young patient. The risk of these complications are increased during simultaneous bilateral hip arthroscopy. Indications: We describe a new technique, which will prevent such problems by using a postless pink pad technique in order to achieve adequate hip distraction. Technique Description: Arthroscopic investigation begins with proper, safe patient positioning in order to gain access to the hip joint with sufficient joint distraction. In the postless technique, a dense foam pad is utilized in lieu of a perineal post. The static friction between the pad, bed, and the patient counters the manual gross traction necessary to distract the hip joint while preventing the patient from sliding down or off of the operating table. The postless technique avoids pressure to the perineum and also allows for greater range of motion during dynamic intraoperative examination and femoroplasty. After hip distraction, standard portal placement allows for access to the central compartment in order to assess intraarticular pathology. Once identified on diagnostic arthroscopy, appropriate techniques are utilized to correct acetabular-sided pincer lesions, labral tears, and femoral-sided cam deformities. Results: When discussing this technique with patients, it is important to highlight that it diminishes the possibility of iatrogenic pressure injury to the pudendal nerve and skin of the perineum. The risk of these injuries typically occurs when the pudenal nerve is compressed against the post during traction and abduction. As such, postless technique prevents any compression and pressure to these regions. Discussion/Conclusion: Hip arthroscopy is a minimally invasive, low morbidity technique for treating a variety of chondral, ligamentous, and bony conditions of the hip. However, studies suggest that pudenal nerve injury is seen in up to 4.3% of patients following hip arthroscopy. Given avoidance of iatrogenic post complications, we describe a postless technique for achieving hip distraction during hip arthroscopy.

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Letter concerning “Traction force for peroperative hip dislocation in hip arthroscopy” by Röling et al.

Hip International ◽

10.1177/1120700019869022 ◽

2019 ◽

Vol 29 (6) ◽

pp. NP6-NP6

Author(s):

Mingjin Zhong ◽

Kan Ouyang

Keyword(s):

Hip Arthroscopy ◽

Hip Dislocation ◽

Traction Force

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

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa035 ◽

2020 ◽

Author(s):

Dillon C O’Neill ◽

Matthew L Hadley ◽

Temitope F Adeyemi ◽

Stephen K Aoki ◽

Travis G Maak

Keyword(s):

Femoral Head ◽

Hip Arthroscopy ◽

Traction Force ◽

Substantial Improvement ◽

Head Size ◽

Femoral Head Size ◽

Post Intervention ◽

Before And After ◽

Hip Distraction

Abstract 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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Neuromonitoring Changes During Hip Arthroscopy in the Pediatric Population

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00423 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0042

Author(s):

Trevor J. Shelton ◽

Akash R. Patel ◽

Lauren Agatstein ◽

Brian Haus

Keyword(s):

Hip Arthroscopy ◽

Peroneal Nerve ◽

Pudendal Nerve ◽

Hip Dysplasia ◽

Pediatric Patients ◽

Tibial Nerve ◽

Pediatric Population ◽

Labral Tear ◽

Posterior Tibial Nerve ◽

Posterior Tibial

Objectives: The objectives of this study were to determine the prevalence, pattern, and predisposing factors for sciatic, femoral, obturator, and pudendal nerve injury during hip arthroscopy in the pediatric population. Methods: We retrospectively reviewed charts of all pediatric patients who underwent hip arthroscopy with neuromonitoring from 2013 until May 2018. Neuromonitoring included when traction was applied and removed, and somatosensory evoked potentials (SSEP) in the peroneal and posterior tibial nerves and electromyography (EMG) signal for the obturator, femoral, and peroneal and posterior tibial branch of the sciatic nerves. Each report was reviewed for total traction time, EMG changes, SSEP changes more than 50% after traction application, and the time for SSEPs to return to baseline. Demographic data and postoperative notes were reviewed for any signs of clinical nerve injury and if/when recovery occurred. We determined the rate of SSEP and EMG changes, time from traction onset to SSEP and EMG changes, time after traction released until SSEP returns to baseline, and rate of neuropraxia and any potential risk factors. Results: We identified 78 patients who underwent hip arthroscopy (16±2 years of age; 54 females). Reasons for hip arthroscopy included femoral acetabular impingement (37%), hip dysplasia with labral tear (27%), slipped capital femoral epiphysis (23%), labral tear (5%), snapping hip (3%), diagnostic scope (3%), Perthes with labral tear (1%), and trauma (1%). Average traction time was 64±30 min. SSEPs decreases of less than 50% occurred in 76% of patients in the peroneal nerve, and 69% of patients in the posterior tibial nerve. In the contralateral limb, there was a 50% drop in SSEPs in the peroneal nerve in 13% of patients and in the posterior tibial nerve in 8% of patients. For the peroneal nerve, this drop in signal occurred 23±11 min after traction was applied and returned intraoperatively at a rate of 74% 29±23 min after traction removal. For the posterior tibial nerve, this drop in signal occurred 22±12 min after traction was applied and returned intraoperatively at a rate of 83% 24±15 min. after traction removal. EMG activity was observed after traction application in 10% of patients in the obturator nerve at 36±34 min., 9% of patients in the femoral nerve at 22 ± 15 min., 14% of patients in the peroneal nerve at 19±27 min, and 5% of patients in the posterior tibial nerve at 42±42 min. The rate of pudendal nerve neuropraxia was 0%. The rate of clinical neuropraxia postoperatively was 18%. Those who sustained a neuropraxia had on average a 54 min. longer surgery (p=0.005) and a trend towards a 14 min. longer traction time (p=0.096). Diagnosis had no statistical effect on the rate of clinical diagnosis. Conclusion: Hip arthroscopy is increasingly utilized to treat several unique diagnoses in the pediatric population. As such, it is important to understand the potential risks of treating different diagnosis in this population. The important findings of this study are that neuromonitoring changes occur in more than 70% of patients and 18% will have some decreased sensation in either their peroneal nerve or posterior tibial nerve that resolves within 1-2 days after surgery. There is also a low risk of neuropraxia if there are no neuromonitoring changes during surgery. Diagnosis (Hip dysplasia/SCFE/FAI) did not change incidence of neuropraxia. Longer surgery and traction time appear to be the only risk factors for neuropraxia in hip arthroscopy in pediatric patients.

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Differential Effects of Hip Rotation Range on Knee Abduction Biomechanics during Double-Legged Landing between Males and Females

The Asian Journal of Kinesiology ◽

10.15758/ajk.2020.22.4.34 ◽

2020 ◽

Vol 22 (4) ◽

pp. 34-47

Author(s):

Tadashi Yasuda ◽

Keiichi Oyanagi ◽

Miyu Nakagaki ◽

Hiromitsu Itoh

Keyword(s):

Muscle Strength ◽

External Rotation ◽

Muscle Mechanics ◽

Abduction Angle ◽

Drop Landing ◽

Peak Knee ◽

Hip Abduction ◽

Knee Abduction ◽

Males And Females ◽

Hip Rotation

OBJECTIVES Dynamic knee valgus is composed of hip-knee coupling. While females differ from males in passive hip motion, hip rotation range may alter muscle mechanics and neuromuscular activity. This study aimed to compare knee abduction biomechanics during double-legged drop-landing between males and females with different hip rotation ranges.METHODS This study included five females with the range of hip internal rotation (IR) > the range of hip external rotation (ER), five females with ER>IR, four males with IR>ER, and five males with ER>IR. There was no difference in other hip motions among them or no difference in hip muscle strength between the same sex groups. Three-dimensional motion analyses of the hip and knee joints were performed during double-legged drop-landing.RESULTS Multiple regression analysis of females with IR>ER showed that peak knee abduction moment (KAM) was associated with maximal hip abduction moment before detecting peak KAM whereas peak knee abduction angle (KAA) correlated with no variable. In females with ER>IR, peak KAM was associated with maximal hip ER moment before detecting peak KAM, hip ER muscle strength and hip adduction range while peak KAA correlated with peak hip abduction moment before detecting peak KAM. In males with IR>ER, peak KAM was associated with hip ER range and hip adductor strength whereas peak KAA correlated with maximal hip ER moment and maximal hip IR angle during landing. In males with ER>IR, peak KAM was associated with hip extensor strength, hip abduction range and hip flexion range whereas peak KAA correlated with hip ER moment before detecting peak KAM, hip ER muscle strength, and hip adduction range.CONCLUSIONS Hip rotation range may differentially affect hip-knee coupling strategy for knee abduction control during double-legged drop-landing between males and females.

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Effect of hip abduction angle on trunk muscle activation during plank exercise

10.31083/jomh.2021.122 ◽

2021 ◽

pp. 1

Keyword(s):

Muscle Activation ◽

Trunk Muscle ◽

Abduction Angle ◽

Hip Abduction

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Relationships between Hip Flexibility and Pitching Biomechanics in Adolescent Baseball Pitchers

Journal of Athletic Training ◽

10.4085/1062-6050-0103.21 ◽

2021 ◽

Author(s):

Maxwell L. Albiero ◽

Wesley Kokott ◽

Cody Dziuk ◽

Janelle A. Cross

Keyword(s):

External Rotation ◽

Pearson Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Kinematic Chain ◽

Abduction Angle ◽

Cross Sectional ◽

Flexion Extension ◽

Hip Abduction ◽

Baseball Pitchers

Abstract Context: Inadequate hip active range of motion (AROM) may stifle the energy flow through the kinematic chain and decrease pitching performance while increasing the risk for pitcher injury. Objective: To examine the relationship of hip AROM and pitching biomechanics during a fastball pitch in adolescent baseball pitchers. Design: Cross-Sectional study. Setting: Biomechanics laboratory. Participants: A voluntary sample of 21 adolescent baseball pitchers (16.1 ± 0.8 yrs.; 183.9 ± 5.2 cm; 77.9 ± 8.3 kg). Main Outcome Measure (s): Bilateral hip internal rotation (IR), external rotation (ER), flexion, extension, and abduction AROM were measured. Three-dimensional biomechanics were assessed as participants threw from an indoor pitching mound to a strike zone net at regulation distance. Pearson correlation coefficients were used to determine correlations between hip AROM and biomechanical metrics. Results: Statistically significant negative correlations were found at foot contact between back hip ER AROM and back hip abduction angle (p=0.030, r=−0.474), back hip ER AROM and torso rotation angle (p=0.032, r=−0.468),and back hip abduction AROM and lead hip abduction angle (p=0.037, r=−0.458). Back hip extension AROM was positively correlated with increased stride length (p=0.043, r=0.446). Lead hip abduction AROM was also positively correlated with normalized elbow varus torque (p=0.034, r=0.464). Conclusions: There were several relationships between hip AROM and biomechanical variables during the pitching motion. The findings support the influence hip AROM can have on pitching biomechanics. Overall, greater movement at the hips allows for the kinematic chain to work at its maximal efficiency, increasing pitch velocity potential.

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