Perineal Pressure During Hip Arthroscopy Is Reduced by Use of Trendelenburg: A Prospective Study With Randomized Order of Positioning
Authors: Lall AC, Saadat AA, Battaglia MR, Maldonado DR, Perets I, Domb BG
DOI: 10.1097/CORR.0000000000000804
Background
- Traction during hip arthroscopy improves visualization but may increase perineal pressure causing nerve injuries or soft tissue damage.
- The study investigates whether Trendelenburg positioning (head-down tilt) reduces perineal pressure during surgery.
Methods
- Prospective study of 50 patients with perineal pressure measured at 0°, 5°, 10°, and 15° Trendelenburg positions.
Key Findings
- Trendelenburg positioning at 10° and 15° reduced perineal pressure by 28% and 46% compared to neutral.
Conclusions
- Applying Trendelenburg positioning can significantly reduce perineal pressure, potentially lowering risk of traction-related complications.
What Does This Mean for Providers?
- Consider incorporating Trendelenburg positioning (at least 10° tilt) during hip arthroscopy to reduce perineal pressure.
- Reduced pressure may decrease nerve injury and soft tissue complications associated with traction.
- Optimize patient positioning as a simple, effective strategy to enhance procedural safety.