The Pink Pad: A Method of Post-Free Distraction During Hip Arthroscopy

Distraction is essential during hip arthroscopy to allow for adequate working space during central and peripheral compartment procedures. Pudendal posts are frequently used with traction boots to achieve distraction, but use of these posts is believed to be associated with the iatrogenic pudendal area and perineal nerve injuries seen with hip arthroscopy. Current post-free distraction tables are costly and cumbersome. The pink pad positioning device allows for post-free distraction through the creation of friction between the patient, the pad, and the bed. This device can be used with a standard hip arthroscopy table, is easy to learn, allows for adequate distraction, and allows for greater access to the femoral neck during osteochondroplasty, as there is less restriction of the patient’s range of motion without a post present. The purpose of this Technical Note is to describe a method of post-free distraction using the pink pad positioning device.
Technique Video Video 1 This video describes the key aspects of use of the pink pad positioning device during left hip arthroscopy. The pink pad is placed on top of a standard hip arthroscopy bed, with the widest portion of the pad matching up with the widest portion of the bed attachment. After the distal portion of the pad is secured to the bed attachment using the wide purple Velcro straps, the remainder of the pad is secured to the Bucky arms of the bed using the thin white Velcro straps. A draw sheet is placed onto of the bed, and safety straps are attached to the Bucky arms. The patient is moved onto the bed, anesthetized, and moved in the caudad direction until the anterior superior iliac spine is in line with the widest portion of the pad. The draw sheet is removed from under the patient, and the patient’s arms are secured in position with tape and safety straps. The arms may both be folded across the chest, or the arm contralateral to the surgery side may rest on an arm board. The patient’s feet are placed in traction boots, and the operative side is secured with Coban. The patient is placed in 10-15° Trendelenburg position with the leg adducted and the foot internally rotated. After a clear fluoroscopic field is confirmed with a C-arm, the patient is prepped and draped in sterile fashion. An air arthrogram is performed to disrupt the suction seal under fluoroscopy. Maximum traction is then achieved through adjustment of the distal traction arm. An interportal capsulotomy is created, and central compartment procedures (rim trimming, labral repair) are performed. Traction is released, and a T-capsulotomy is created to access the peripheral compartment. The procedure is completed with capsular and portal closure.