Hip arthroscopy is widely regarded as the most difficult joint to perform arthroscopy on, and demands optimal patient positioning, surgical instrumentation and, most importantly, surgeon skill and experience. Traditionally, labral repair and/or reconstruction, when performed arthroscopically, were done on a traction table. Through the use of traction and a perineal post, surgeons were able to distract the hip joint enough to enter it with their arthroscopic instruments.
This distraction however, came at a cost. Postoperative pudendal neuralgia, sexual dysfunction, genital numbness and genitourinary symptoms were extremely common postoperatively, with up to 50% of patients experiencing one of the above symptoms. While these adverse effects often subsided within a few months, 20% of patients still have symptoms up to one year postoperatively.
Labral Repair or Reconstruction
The current treatment of acetabular labral tears is based around labral repair and/or reconstruction. Traditionally, frayed and/or degenerative labra were debrided. Studies demonstrated inferior outcomes with debridement versus repair or reconstruction. With repair and reconstruction, surgeons are able to recreate the labral suction-seal, which restores normal fluid dynamics and hip biomechanics.
Recently, surgeons have begun augmenting their labral repairs with grafts, in order to better restore natural anatomy. Short and mid-term outcomes of repair and reconstruction have been promising, with multiple studies demonstrating predictable pain relief, improvement in hip-related quality of life and, for athletes, high return to play rates.
Repair and reconstruction are performed arthroscopically, and utilize a variety of anchors and graft materials. These surgeries are typically performed on an outpatient basis, and demand a prolonged course of post-operative rehabilitation and therapy in order to maximize outcomes.
Acetabular Labral Tear
Acetabular labral tears are a common cause of athletic hip pain in adolescent and young adult populations. Often secondary to femeoracetabular impingement (FAI) or hip dysplasia, labral tears affect the underlying suction-seal of the femoral-head-acetabulum ball-and-socket, and lead to pain, apprehension and instability. Certain repetitive motions or sports predispose athletes or individuals to labral tears.
Specifically, hip flexion, adduction and internal rotation can place the labrum in a position in which it is exposed to supraphysiologic stress or strain. This position can be exacerbated by underlying FAI, which creates abnormal contact interfaces. In the dysplastic hip, abnormal anatomy can afflict the labrum with altered ball-and-socket motion which can create areas of high stress. In addition, globally lax individuals have also been found to suffer labral tears at higher rates.
The Stryker Pivot Guardian™ is the first-ever table designed specifically for hip arthroscopy. It attaches to a typical operating room table, and utilizes the Trendelenburg position and the patient’s own bodyweight to distract the hip joint. There is no pudendal post to compress the genitalia and surrounding nerves.
In addition, the table design allows for much easier intraoperative imaging, which can decrease surgical time. Recent studies have shown a near total elimination of pudendal neuralgia and genitourinary complaints through the use of the Stryker Pivot Guardian™.