Hip Preservation: Novel Technique Eliminates Traction-Related Groin Complications During Hip Arthroscopy

Hip pain or a muscle strain might call for physical therapy, while arthritis may call for a hip replacement; for many years, these represented the duopoly of treatment options for patients with hip pain.

As knowledge and clinic identification of hip pathologies and pre-arthritic conditions such as hip impingement and labral tears has increased over the last 10-20 years, however, so have technology and the treatment approaches for the vast swath of patients between these two poles, with an ever-increasing focus on hip joint preservation.

In a presentation titled “Exploiting the benefits of post-less hip arthroscopy: The on-off traction technique during the labral repair to restore the labral suction seal,” Allina Health orthopedic surgeon Ryan Fader, MD introduced his technique for utilizing post-less arthroscopy at the International Society for Hip Arthroscopy meeting this past October in Glasgow, Scotland. 

The use of a padded post as a fulcrum point for pulling traction in traditional arthroscopic hip procedures has been associated with a range of postoperative complications that include erectile issues, sexual dysfunction, groin pain and numbness, urinary problems, and lacerations.

With a post-less bed like the Stryker Pivot Guardian hip distraction system employed by Dr. Fader, though, patients are able to undergo safer surgery utilizing a special booting system that eliminates pressure points on the feet and achieves distraction through the hip joint without having to compress the groin at all—eliminating the risk of postoperative groin complications.

Furthermore, Dr. Fader relies on Stryker’s post-less system to “provide more dynamic control during the surgery…[and] achieve a more anatomic repair of the labrum.”

Dr. Fader explains that the ability to come on and off traction throughout the 60 to 90-minute procedure better allows him to “anatomically reduce the labrum while the joint is reduced, allowing for better restoration of labral suction seal for the hip joint.”

The placement of patients in the Trendelenburg position with post-less technique also has other advantages: It both reduces bleeding and allows for lower pump pressures. Less water being pumped through the hip leads to less swelling and, potentially, less postoperative pain.

Dr. Fader has completed more than 700 post-less hip arthroscopies, among the most in Minnesota, on patients ranging in age from 12 to 65. His ability to lean into new technology and invent and publish this technique has been aided by Allina Health’s investment in three Pivot Guardian systems.

The goal, Dr. Fader says, is “to make this procedure as technically reproducible as possible, which, therefore, translates to more reproducible and improved outcomes in these patients, while eliminating some of the risks and complications that we see in hip arthroscopy.”

He hopes that these reproducible outcomes—and possible force studies in the future—will show other surgeons what is possible and encourage them to adopt this post-less technique.

And while he has had patients travel to the Twin Cities from Greater Minnesota and the surrounding states for the procedure, Dr. Fader’s ambitions are far broader: He is in the early phases of development of a hip preservation center at Allina Health—one that has more post-less beds and encompasses a range of providers, from hip-specific physical therapists, nonoperative specialists, and injection specialists to open-hip surgeons and arthroscopic hip surgeons like himself.

His vision is to build a program that becomes a regional or tertiary referral center for pre-arthritic hip conditions that are becoming better understood and more routinely treated.

For a surgeon accustomed to being on the cutting edge of hip preservation treatment, it’s the next logical step.

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