Intraarticular Central Compartment

The perineal post is heavily padded and lateralized against the medial thigh of the surgical hip. This aids in achieving the optimal traction vector (Fig. 2) and reduces direct pressure on the perineum, lessening the risk of neuro-praxia of the pudendal nerve. Neutral rotation achieves a constant rela-

Fig. 2. The optimal vector for distraction is oblique relative to the axis of the body, and more closely coincides with the axis of the femoral neck than the femoral shaft. This oblique vector is partially created by abduction of the hip and partially accentuated by a small transverse component to the vector created by lateralizing the perineal post. (From Byrd JWT. The supine approach. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd edition. New York: Springer; 2005. p. 145-69; with permission.)

Fig. 2. The optimal vector for distraction is oblique relative to the axis of the body, and more closely coincides with the axis of the femoral neck than the femoral shaft. This oblique vector is partially created by abduction of the hip and partially accentuated by a small transverse component to the vector created by lateralizing the perineal post. (From Byrd JWT. The supine approach. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd edition. New York: Springer; 2005. p. 145-69; with permission.)

tionship between topographic landmarks and the joint. Slight flexion may relax the capsule, but excessive flexion should be avoided, as this places undue tension on the sciatic nerve and may block access for the anterior portal. Approximately 50 pounds of force is typically needed to distract the joint. In general, the goal is to use the minimal force necessary to achieve adequate

Fig. 3. The site of the anterior portal coincides with the intersection of a sagittal line drawn distally from the anterior superior iliac spine and a transverse line across the superior margin of the greater trochanter. The direction of this portal courses approximately 45° cephalad and 30° toward the midline. The anterolateral and posterolateral portals are positioned directly over the superior aspect of the trochanter at its anterior and posterior borders. (From Byrd JWT. Hip arthroscopy using the supine position. Arthroscopy 1994;10(3):275-80; with permission.)

Fig. 3. The site of the anterior portal coincides with the intersection of a sagittal line drawn distally from the anterior superior iliac spine and a transverse line across the superior margin of the greater trochanter. The direction of this portal courses approximately 45° cephalad and 30° toward the midline. The anterolateral and posterolateral portals are positioned directly over the superior aspect of the trochanter at its anterior and posterior borders. (From Byrd JWT. Hip arthroscopy using the supine position. Arthroscopy 1994;10(3):275-80; with permission.)

distraction and keep traction time as brief as possible. (Less than 2 hours is usually considered optimal.)

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