How is the patient positioned for hip arthroscopy?

Updated: Apr 10, 2019
  • Author: Bart Eastwood, DO; Chief Editor: Dinesh Patel, MD, FACS  more...
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Answer

Hip arthroscopy has been done in both the lateral decubitus position and the supine position; to date, the latter has been more commonly employed. [16]  Traction is placed on both the well leg and the leg to be operated on. Careful padding and secure fixation of the ankle in the traction device are important both for preventing peripheral nerve injury and for ensuring that traction force can be dependably applied without slipping. Close attention should be paid to positioning the traction post laterally against the medial thigh; this provides a more ideal traction vector for hip access and removes pressure on the pudendal nerve (thereby avoiding neurapraxia).

As noted, the patient should be positioned on the table in such a way as to permit flexion, extension, abduction, and rotation (internal and external). There should be sufficient room for C-arm positioning, and the C-arm and arthroscopy monitors should be readily visible. In many cases, 50 lb of traction is required to distract the hip. Prolonged traction (ie, >2 hours) may place the patient at increased risk for neurovascular complications, typically neurapraxias. [3, 6, 13, 8]


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