Background
Postless hip arthroscopy is an emerging technique that helps to avoid potential soft tissue and nerve complications of using a perineal post during hip arthroscopy. The purpose of this study was to perform a systematic review to identify the various techniques used to perform postless hip arthroscopy.
Methods
A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify surgical technique articles or clinical studies describing techniques for the use of postless hip arthroscopy. Specific items sought for analysis included hip arthroscopy for femoracetabular impingement including cam or pincer-type lesions, surgical time, traction time, traction force, bed Trendelenburg angle, intraoperative techniques, and postoperative outcomes, including complications. Exclusion criteria included any postless techniques used for open hip surgeries such as periacetabular osteotomy, sports hernia, peritrochanteric work, gluteus medius repair, ischiofemoral impingement, hamstring repair, or need for intraoperative conversion from postless to posted technique. Study heterogeneity and low level of evidence precluded meta-analysis.
Results
Ten studies (1 level III, 3 level IV, 6 level V) were analyzed (1,341 hips, 51.5% male, mean age 31.5 years). In 4 studies, Trendelenburg position with a foam pad (The Pink Pad; Xodus Medical Inc.) was used at 5-20 degrees. The average traction force and time was 65.1 pounds and 59.7 minutes, respectively. The remaining studies used the Yoga Mat technique, the Tutankhamun technique, the Beanbag technique, and the Hip Arthroscopy Post-less Procedure Impingement (HAPPI) technique. No patients fell off the bed and there was only one incident of pudendal neurapraxia, which resolved spontaneously at 6 weeks without complication. There were no cases where sufficient distraction was unable to be obtained by postless techniques.
Conclusion
Postless hip arthroscopy can be safely performed with a variety of techniques. Obtaining adequate traction and countertraction can be achieved through these postless methods.