Patient Positioning for Postless Hip Arthroscopy

Hip arthroscopy has been on the rise since its inception. Initial descriptions of the procedure required skeletal traction of the operative extremity with countertraction provided by a perineal post. Perineal posts are associated with complications such as perineal nerve palsy, genital laceration, and hematoma formation. Postless traction has been developed to avoid complications related to use of perineal posts. A patient is positioned supine on a postless traction table (Guardian; Stryker, Greenwood Village, CO) with a disposable traction pad. The anterior superior iliac spine is positioned at the distal aspect of the semicircle cutout in the traction pad. The patient is placed in approximately 3° of Trendelenburg positioning. Both lower extremities are secured into traction boots. The operative extremity is prepared and draped in the standard sterile fashion. Traction is applied to the operative extremity with countertraction being applied manually to the pelvis during hip dislocation. Many pathologies around the hip including femoral acetabular impingement can be effectively managed with hip arthroscopy. Postless hip arthroscopy is an effective method of obtaining sufficient traction for hip dislocation. Significant complications related to the perineal post can be avoided with postless traction. We expect postless traction use to increase in hip arthroscopy.