Good afternoon. Today I'll be presenting about the effects of capsulotomy and traction force in hip distraction in hip arthroscopy patients. I'd like to thank my co-authors listed here for their help in completing this study. Successful hip arthroscopy requires balancing the benefits of adequate joint distraction with the detriments of increasing levels of lower extremity traction. Joint distraction is necessary for adequate visualization and instrumentation. Conversely, traction-related complications occur in up to 7% of patients and are most closely associated with the magnitude of axial traction used intraoperatively. Venting of the acetabular labrum and capsulotomy of the hip have been hypothesized to reduce the amount of traction required to achieve adequate joint distraction. Both procedures have demonstrated benefit in cadaveric models, however, they've not been directly compared in an in vivo study. We designed this current study to evaluate the effects of venting and capsulotomy on the ratio of hip distraction distance to traction force when both interventions are performed in the same procedure. Additional baseline data were collected to evaluate whether primary revision status, age, BMI, or sex affected this ratio. All patients of two attending hip surgeons with an isolated diagnosis of FAI were prospectively enrolled in the study provided they didn't have clinically significant osteoarthritis or require treatment of additional hip pathology. Continuous traction force monitoring was built into our traction device and venting and capsulotomy moments were subsequently identified by analyzing digital traction output for each patient. Displacement measurements were calculated by comparison to a pretraction radiograph and normalized based on each patient's femoral head size. This slide summarizes our study design. After a pretraction radiograph was obtained, traction was applied. The central compartment was vented using a spinal needle and a standard interportal capsulotomy was performed. Radiographs for displacement measurements were obtained immediately after each intervention. So 107 patients, 85 primary and 22 revision, were prospectively enrolled and included in the final analysis. Primary and revision groups statistically differed only in that one surgeon performed more revision surgeries. For the entire cohort, venting and capsulotomy resulted in 2.66 and 2.87% reductions in traction force respectively. Distraction distance was approved by approximately 2% for each intervention. The ratio of distraction distance to traction force was significantly improved by both venting and capsulotomy for all patients regardless of revision status. Multivariate regression demonstrated that revision status was independently predictive of larger improvements in the distraction to traction ratio for venting. Conversely, revision status was associated with a smaller response to capsulotomy, but this value did not reach significance. Male sex independently predicted a smaller response to venting and capsulotomy. This study has several limitations, but the one I want to talk about is the fact that venting and capsulotomy were performed only after adequate distraction had been achieved. It's possible that performing one or both of these procedures prior to the application of full traction might alter the magnitude of their demonstrated benefits, particularly because the highest traction forces occur immediately after the application of traction, as illustrated in this representative continuous traction force output you can see on the slide there. Despite the study's limitations, we believe these data illustrate that venting and capsulotomy each independently improved the distraction to traction relationship when performed in the same procedure. Additionally, our data re-demonstrate that male sex is associated with smaller levels of benefit for both procedures. Importantly, the magnitude of response to venting and capsulotomy in the study was small, with improvements in reduced traction force and increased distraction distance between two to three percent for each intervention. This is in contrast with previously published studies which have demonstrated substantially larger reductions in traction force for a fixed distraction distance. Although these studies are not perfect direct comparisons, our data imply that performing venting and capsulotomy once sufficient hip distraction has already been obtained may not confer the same level of benefit in terms of traction force reduction as suggested by previous research. Thanks for your time.

capsulotomy

venting

hip distraction

hip arthroscopy

traction force