Uploaded October 2025 | Updated September 2026, 2 weeks ago
Postless hip arthroscopy continues to gain popularity as surgeons seek safer, more ergonomic alternatives to traditional perineal post traction. In this hip distraction system live case, we demonstrate a complete workflow for postless hip arthroscopy, highlighting patient positioning, traction application, portal access, femoral osteoplasty, and capsular management.
The case begins with standard patient positioning, emphasizing secure padding and alignment identical to traditional posted techniques. Three blankets are used for stability and comfort, and traction boots are applied with the hips in flexion to optimize heel fit and control. Unlike posted arthroscopy, this hip distraction system eliminates perineal compression, significantly reducing the risk of pudendal and peroneal nerve palsy.
Traction is achieved through a team‑based, three‑person technique: one person stabilizes the pelvis (primarily contralateral compression), a second applies inline traction, and the surgeon maintains tactile control of traction force. The bed is placed into Trendelenburg (approximately 15–20 degrees) to assist with distraction while maintaining patient stability.
A key advantage demonstrated in this live case is the ability to:
Titrate traction in real time
Easily move in and out of traction throughout the procedure
Assess native hip stability without paralytics or a perineal post
Maintain consistent fluoroscopic access
The surgeon transitions seamlessly between traction‑dependent steps (joint access, labral repair, capsular closure) and traction‑free phases such as femoral osteoplasty. Hip positioning is controlled using body mechanics rather than a fixed post, allowing precise visualization of the femoral neck, head‑neck junction, retinacular vessels, and cam deformity during femoroplasty.
From an anesthesia perspective, postless hip arthroscopy provides significant benefits:
No paralytics required
Improved pain titration
No reversal agents needed
Enhanced recovery and discharge efficiency, ideal for ASC and outpatient settings
Capsular repair is performed with traction reapplied only as needed, showcasing one of the main technical advantages of postless distraction, which is rapid transitions without re‑positioning hardware. The surgeon emphasizes reduced postoperative pain, improved patient comfort, and elimination of post‑related complications.
The video also covers pearls and pitfalls, including:
Importance of pre‑case team coordination
Performing dry runs with the OR team
Maintaining pelvic compression to prevent sliding
Accurate positioning relative to the pad’s alignment markers
Strategic partial traction before prep and drape to facilitate later distraction
After more than five years and over a thousand cases using this technique, the surgeon concludes that the postless approach has proven safe, reproducible, and superior for both patients and the surgical team.
💬 If this live case was helpful, like, subscribe, and comment below. Share your experience with postless hip arthroscopy or questions about transitioning away from perineal posts.
👇 Helpful Arthrex Reference Links:
arthrex.info/46VFp8P
arthrex.com/resources/VID1-002966-en-US/hip-distraction-system-traction-boot-ii-product-demonstration?objectID=human.resource.en.3c84f63b-5ec7-5837-8b76-4721d83f7f32.2&queryID=a016bb7f5979606f182b5377cf6cfeb2
👍 Like, subscribe, and comment if you’d like to see more patient success stories and innovations in minimally invasive orthopedic procedures.
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
Postless hip arthroscopy continues to gain popularity as surgeons seek safer, more ergonomic alternatives to traditional perineal post traction. In this hip distraction system live case, we demonstrate a complete workflow for postless hip arthroscopy, highlighting patient positioning, traction application, portal access, femoral osteoplasty, and capsular management.
The case begins with standard patient positioning, emphasizing secure padding and alignment identical to traditional posted techniques. Three blankets are used for stability and comfort, and traction boots are applied with the hips in flexion to optimize heel fit and control. Unlike posted arthroscopy, this hip distraction system eliminates perineal compression, significantly reducing the risk of pudendal and peroneal nerve palsy.
Traction is achieved through a team‑based, three‑person technique: one person stabilizes the pelvis (primarily contralateral compression), a second applies inline traction, and the surgeon maintains tactile control of traction force. The bed is placed into Trendelenburg (approximately 15–20 degrees) to assist with distraction while maintaining patient stability.
A key advantage demonstrated in this live case is the ability to:
Titrate traction in real time
Easily move in and out of traction throughout the procedure
Assess native hip stability without paralytics or a perineal post
Maintain consistent fluoroscopic access
The surgeon transitions seamlessly between traction‑dependent steps (joint access, labral repair, capsular closure) and traction‑free phases such as femoral osteoplasty. Hip positioning is controlled using body mechanics rather than a fixed post, allowing precise visualization of the femoral neck, head‑neck junction, retinacular vessels, and cam deformity during femoroplasty.
From an anesthesia perspective, postless hip arthroscopy provides significant benefits:
No paralytics required
Improved pain titration
No reversal agents needed
Enhanced recovery and discharge efficiency, ideal for ASC and outpatient settings
Capsular repair is performed with traction reapplied only as needed, showcasing one of the main technical advantages of postless distraction, which is rapid transitions without re‑positioning hardware. The surgeon emphasizes reduced postoperative pain, improved patient comfort, and elimination of post‑related complications.
The video also covers pearls and pitfalls, including:
Importance of pre‑case team coordination
Performing dry runs with the OR team
Maintaining pelvic compression to prevent sliding
Accurate positioning relative to the pad’s alignment markers
Strategic partial traction before prep and drape to facilitate later distraction
After more than five years and over a thousand cases using this technique, the surgeon concludes that the postless approach has proven safe, reproducible, and superior for both patients and the surgical team.
💬 If this live case was helpful, like, subscribe, and comment below. Share your experience with postless hip arthroscopy or questions about transitioning away from perineal posts.
👇 Helpful Arthrex Reference Links:
arthrex.info/46VFp8P
arthrex.com/resources/VID1-002966-en-US/hip-distraction-system-traction-boot-ii-product-demonstration?objectID=human.resource.en.3c84f63b-5ec7-5837-8b76-4721d83f7f32.2&queryID=a016bb7f5979606f182b5377cf6cfeb2
👍 Like, subscribe, and comment if you’d like to see more patient success stories and innovations in minimally invasive orthopedic procedures.
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
