Distraction Gap Needed for Safe Central Compartment Access in Hip Arthroscopy

Area of Science:

• Orthopedic Surgery
• Arthroscopy
• Biomechanical Analysis

Background:

• Achieving adequate hip distraction is crucial for safe central compartment (CC) access during hip arthroscopy.
• A scientifically defined threshold for sufficient distraction gap remains elusive.

Purpose of the Study:

• To establish the necessary distraction amount for successful CC access in hip arthroscopy.
• To identify risk factors associated with failed or difficult CC access.

Main Methods:

• A case-control study involving 240 patients undergoing hip arthroscopy.
• Analysis of hip joint distraction ratios using C-arm fluoroscopy under various traction conditions.
• Comparison of distraction amounts and patient demographics between successful and failed/difficult CC access groups.

Main Results:

• A >2.2x increase in lateral gap under preoperative maximal traction predicted successful CC access (P < .001).
• A >2.7x increase in lateral gap under intraoperative maximal traction also predicted success (P < .001).
• Male sex (OR, 2.94) and increased lateral center-edge angle (OR, 1.08) were significant risk factors for failed/difficult CC access.

Conclusions:

• A >2.2x lateral gap increase during preoperative traction reliably predicts successful central compartment access.
• Male sex and a larger lateral center-edge angle are identified as risk factors for challenging CC access in hip arthroscopy.