What did the study look at?
During hip arthroscopy (keyhole surgery of the hip), the leg has to be pulled so that the joint opens up enough for the surgeon to work inside it (distraction). This is usually done with a post placed between the legs (a pudendal or perineal post). The authors note that the post has been linked with nerve and skin injuries in the groin area, and that existing post-free tables are costly and cumbersome. The aim of the article is to describe a post-free distraction method using a pink pad positioning device.
How was it done?
This is not a patient study but a video-supported surgical technique note. The authors describe the following steps:
- The pink pad is secured to a standard hip arthroscopy table with Velcro straps.
- The patient lies on their back under general anaesthesia, with the front point of the pelvis aligned with the widest part of the table attachment; the draw sheet is removed to maximise skin contact with the pad.
- The feet are placed in traction boots; the table is tilted 10-15 degrees head-down (Trendelenburg), the leg is brought inwards and the foot is turned inwards.
- Under fluoroscopy (live X-ray), 60 cc of air is injected into the joint to break the suction seal, and traction is applied until a gap of at least 1 cm is achieved.
What did it find?
The authors list these advantages: elimination of groin injuries caused by the post; an inexpensive, disposable item that is easy to store; compatibility with all standard tables; and, without a post, freer rotation of the leg. They state that this makes it easier to check whether the bump on the thigh bone neck (cam lesion) has been removed adequately. Citing earlier literature, they report that perineal and pudendal nerve complications occur in up to 4.3% of cases.
The drawbacks described are that the patient cannot be slid on the pad and must be lifted to be moved, that patients weighing less than about 120 pounds may need a steeper head-down tilt, that the pelvis may tilt forward during traction, and that over-tightened straps can tear the pad.
The authors' conclusion
The authors conclude that the pink pad is a cost-friendly and user-friendly positioning device that eliminates post-related complications in hip arthroscopy. They stress, however, that it cannot prevent all complications of hip arthroscopy.
Limitations
The article is a technique description and does not present comparative patient outcome data. The authors also note that the surgical team needs to learn the new set-up, that the fluoroscopic view may differ from what surgeons are used to in lighter patients, and that pelvic tilt should be corrected when recognised.
Reference
Perry AK, Gürsoy S, Singh H, Vadhera AS, Mehta N, Chahla J. (2021). The Pink Pad: A Method of Post-Free Distraction During Hip Arthroscopy. Arthroscopy Techniques, 10(8), e1897–e1902. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2021.04.013
Free full text: PMC8355178
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
