Use of an independent skeletal distractor in hip arthroscopy

Distraction of the hip joint plays an important role in hip arthroscopy by improving visualization of and access to intra-articular structures. Distraction is usually performed by use of a standard traction table and foot plate, with the patient in either the supine or lateral position. Between 1996 and 2005 at our institution, we have used an inexpensive, independent, sterile radiolucent skeletal distractor device to perform hip arthroscopy in the lateral position successfully in 156 cases for a variety of indications and procedures. The device consists of a perineal post, a longitudinal distraction beam, and a telescoping distraction carriage fitted with a screw drive for attachment to a distal femoral K-wire. Skeletal traction is applied against the perineal post through the K-wire via the action of the distraction carriage and fine-tuned with the screw drive, affording excellent visualization of intra-articular structures. The use of this device during hip arthroscopy negates the need for a fracture table, enables the surgeon to remain sterile and still manipulate the traction apparatus intraoperatively, and provides for simultaneous hip and knee flexion to relax the sciatic nerve. Its modular design and small size make hip arthroscopy possible in almost all settings, including outpatient operating rooms.