Arthroscopic Hip Patient Positioning Using the

HIP TECHNIQUE GUIDE
Arthroscopic Hip Patient Positioning
Using the Advanced Supine Hip
Positioning System
Prepared in consultation with:
Michael A. Terry, MD
KNEE
HIP
SHOULDER
EXTREMITIES
Arthroscopic Hip Patient Positioning
Using the Advanced Supine Hip
Positioning System
Prepared in consultation with:
Michael A. Terry, MD
Northwestern University Feinberg
School of Medicine
Chicago, IL 60611
The following technique guide was prepared under the guidance of
Dr. Michael A. Terry. Created under close collaboration with the physician,
it contains a summary of medical techniques and opinions based upon his
training and expertise in the field, along with his knowledge of Smith & Nephew’s
Advanced Supine Hip Positioning System. Smith & Nephew does not provide
medical advice and recommends that surgeons exercise their own professional
judgment when determining a patient’s course of treatment. This guide is
presented for educational purposes only.
Prior to performing this technique, consult the Instructions for Use
documentation provided with individual components – including indications,
contraindications, warnings, cautions, and instructions.
The purpose of this technique is to distract the patient’s
leg to allow access to the central compartment of the hip
joint during hip arthroscopy procedures. This technique
requires no fine traction adjustments, is efficient, and
enables easy alignment of the patient’s pelvis. The
technique requires only limited use of fluoroscopy.
The Smith & Nephew Advanced Supine Hip Positioning
System utilizes two Universal Hip Distractors, which easily
attach to most standard operating room tables. The ball
joint of each distractor mast allows the hip to be flexed,
abducted or adducted with the turn of the distractor
positioning handle, providing control over the patient's
legs during hip arthroscopy. After the hip is repositioned,
the system automatically locks into place to prevent
movement. A control system allows both fine and gross
traction adjustments, although the technique described
herein eliminates the need for fine adjustments.
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3
PRODUCT OVERVIEW
System configurations can be customized by technique
and/or surgeon preference. The Advanced Supine Hip
Positioning System is described in this technique while
Traditional Supine and Lateral Hip Positioning Systems
are also available. The Advanced Supine Hip Positioning
System requires two Universal Hip Distractors, while the
traditional supine system employs one Universal Hip
Distractor and one Well Leg Holder.
The Active Heel™ Traction Boot conforms to the patient’s
anatomy to securely hold the patient for the duration
of a hip arthroscopy case1. The design enables the
boot to easily detach from the hip positioning system2
intra-operatively to minimize constraint during dynamic
assessment of the hip, and to provide a wide range of
motion during dynamic assessment of bony work during
femoroacetabular impingement (FAI) procedures. The boot
easily attaches to the system via the quick disconnect
feature,2 so the patient can be secured in the boot prior to
positioning if desired.
Operating Room Set-up
Position the C-arm display at the head of the operating
room (OR) table, with an arthroscopy display above it on
the non-operative side. An additional arthroscopy display
can be placed to the side of the patient’s head on the
operative side.
Arthroscopy display
Tower
Arthroscopy display
C-arm display
Non-operative side
C-arm
OR equipment
Mayo stand
Operative side
4
HI P TEC HN I Q U E G U I DE
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Technique
Patient Positioning with the Advanced
Supine Hip Positioning System
Non-operative side
Operative side
Ulnar nerve
e
F
Sec
on
d
Towels
e
tap
FIGURE 1
t
irs
Sheet to
wrap arm
ta
p
Arm bent to 90º
FIGURE 2
STEP 1
Using two Universal Hip Distractor legs, secure the
patient’s feet in the Active HeelT Traction Boots per the
Instructions for Use (REF 10600768). If using two Universal
Hip Distractor legs with the Leather Boot, refer to that
product's Instructions for Use (REF 10600135).
Note: This may require a manual inspection to ensure that
testicles are out of the compression zone and that labia
are not folded in the compression zone.
Note: Ensure that the boot ball joint knob is loose.
STEP 3
Place the patient’s non-operative side arm on an arm
board on the operating table in a safe and comfortable
position.
Note: If loading the patient’s foot in the Active Heel
Traction Boot pre-operatively, attach the boots to the
distractor legs at this time and complete securing the foot
per the Instructions for Use (REF 10600768). If using the
Active Heel Traction Boot, ensure that the foot is flat and
snug against the bottom of the boot. If using the Leather
Boot, ensure that the foot is flat and snug against the
foot plate.
To help seat the heel in the Active Heel Traction Boot:
a. Form a C-shape with one hand and place it on top the
center strap buckle and pad over the Talus (midfoot).
b. Grasp the loop end of the center strap with the other
hand, and pull the center strap in the direction of the
patient (towards the perineal post when the leg is
straight). Repeat on the other side of the boot.
CAUTION: Do not exceed the Advanced Supine Hip
Positioning System's 330 lb./150 kg patient weight limit.
STEP 2
Position the patient so that the perineal post pad is
between the legs.
Note: Ensure that the perineal post is well seated and
that the patient’s genetalia are not folded or compressed
against the perineal post.
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Note: Shield the gonads to protect against radiation during
fluoroscopy.
STEP 4
Place the patient’s operative side arm across the chest,
then raise the arm to 90° of forward flexion with a
90° bend at the elbow (Figure 1).
Note: Prop up the arm with towels.
STEP 5
Bring the patient’s gown up and over the flexed arm.
Secure the gown with tape (Figure 2).
Note: When taping, bring the tape up and over the arm. Be
sure to pass the tape under the elbow, avoiding the ulnar
nerve. Then pass the tape over the forearm, and secure
the tape.
Note: The tape should come over the arm so that it is well
clear of the ulnar nerve. This provides support to the arm
that is forward flexed to 90º with an elbow at 90º with
internal rotation of the shoulder at 90º. This support does
not compress any neurovascular structures and secures
the limb safely out of the way.
Start a second piece of tape below the patient on the
operative side, bring the tape above the arm, and finish
below the patient on the non-operative side.
5
Technique (continued)
STEP 6
Loosen the carriage knob and the boot
ball joint knob on the non-operative
leg.
Non-operative side
STEP 7
Abduct the non-operative leg
approximately 25–30° by turning the
distractor positioning handle to adjust
the Universal Hip Distractor leg.
Flex the leg approximately 20° and pull
gentle traction on the non-operative
leg. When the desired traction is
acheived, tighten the carriage knob
(Figure 3).
Note: This step balances the pelvis.
The pelvis should now be tilted in the
direction of the non-operative side.
Boot ball
joint knob
Distrator positioning
handle
Operative side
STEP 8
Loosen the carriage knob and the boot
ball joint knob of the operative side
Universal Hip Distractor.
Carriage
knob
FIGURE 3
Non-operative side
STEP 9
Abduct the operative leg
approximately 20°. Flex the operative
leg approximately 10–15°. Pull manual
traction on the operative leg. When the
desired traction is acheived, tighten
the carriage knob (Figure 4).
STEP 10
Note: Ensure that the heel is not lifting
out of the boot.
If the patient's heel is lifting off the
sole of the Active HeelT Traction
Boot, release traction, reposition the
foot in the boot, and tighten the boot
securely.
Operative side
STEP 11
Adduct the operative leg.
FIGURE 4
Note: As the leg is adducted, the
patient’s leg will flex further. Extend
the operative leg to a near-neutral
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HI P TEC HN I Q U E G U I DE
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position to achieve traction. Tighten the boot ball joint knob
(Figure 5).
Note: As the operative leg extends, feel how much traction
is being applied. It should not be necessary to utilize the
fine distraction crank to achieve traction.
STEP 12
The OR staff should put on
lead shields at this point.
Non-operative side
STEP 13
Position the C-arm between
the patient’s legs.
STEP 14
Confirm distraction via
fluoroscopy.
Operative side
STEP 15
Prep and drape the patient.
STEP 16
Pull the instrument cords
from the arthroscopy tower
over the patient.
Be sure that the cords remain
outside of the x-ray field.
STEP 17
Insert an arthroscopy needle into the joint at the
anterior-lateral position. Take one spot x-ray to confirm
that the needle is inside the joint.
FIGURE 5
Note: Ensure that the needle is not going through
the labrum.
STEP 18
Proceed with subsequent portal placement and the hip
arthroscopy case.
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ORDERING INFORMATION
To order the instruments used in this technique, call +1 800 343 5717 in the U.S. or contact an authorized Smith & Nephew
representative.
Reference # Description
Key Smith & Nephew device(s) required for technique*
If you currently have two of the Universal Hip Positioning Systems with
Leather Boots (REF 72200626) and would like to upgrade to the Active
HeelT Traction Boots, order two of the following:
72203992
Active Heel Traction Boot Retrofit Kits for Universal Hip Distractor (1)
Advanced Supine Hip Positioning System†
The technique described requires two Universal Hip Distractors. For
instructions related to the Traditional Supine Hip Positioning System ‡
(1 Universal Hip Distractor and 1 Well Leg Holder) and Lateral Hip
Positioning System, refer to the appropriate Instructions for Use:
Reference # 10600768
Description
Supine and Lateral Hip Positioning Systems with Active Heel Traction Boot
72203990
Active Heel Traction Boot with Universal Hip Distractor** (Leg 1)
72203990
Active Heel Traction Boot with Universal Hip Distractor
(Leg 2)
72201725
Supine Table Attachment with Pad
10600843
Replacement Pads and Straps for the Active Heel Traction Boot
72200631
Perineal Post
10600135
Supine Hip Positioning System with Leather Boot
10600173
Lateral Hip Positioning System with Leather Boot
Supine Rail Clamps
72200636
US Rail Clamps (2)
72200670
EU/UK Rail Clamps (2)
72200671
Denyer Rail Clamps (2)
72200672
Japanese Rail Clamps (2)
72200673
Swiss Rail Clamps (2)
Single-use Disposables
72200634
Perineal Post Pad – Supine
72200635
Boot Insert Pad (2)
Accessories
10600773
Active Heel Traction Boot Retrofit Kits for the Hip Positioning Systems
Active Heel is a trademark of Allen Medical.
* For a full list of Hip Positioning System SKUs, see brochure 00328-1.
** Alternatively, two Universal Hip Distractors with Leather Boots
(REF 72200626) can be used for this technique.
†
Do not exceed the Advanced Supine Hip Positioning System’s
330 lb/150 kg patient weight limit.
‡
Do not exceed the Traditional Supine Hip Positioning System’s
400 lb/181 kg patient weight limit.
CAUTION: U.S. Federal law restricts these devices to sale by or on the order
of a physician.
72200637
Patient Transfer Assembly (for use with supine system only)
72200669
Storage Cart
References
72203800
Active Heel Traction Boot Knee Holder
1. Design Verification Protocol and Report: 15001897, Rev B
2. Design Validation Protocol and Report: 15001898 Rev B
Replacement Parts
72202682
Active Heel Traction Boot
72203275
Active Heel Traction Boot Replacement Kit – Center Strap Assembly
72203345
Active Heel Traction Boot Replacement Kit – Calf, Heel,
and Toe Straps and Strap Pads
72204017
Active Heel Traction Boot Replacement Kit – Pads only
72204018
Replacement Carriage (black sliding mechanism on the boom compatible with the Active Heel Traction Boot)
72200630
Supine Table Attachment Pad
Endoscopy
Smith & Nephew, Inc.
150 Minuteman Road
Andover, MA 01810
USA
www.smith-nephew.com
+1 978 749 1000
+1 978 749 1108
Fax
+1 800 343 5717
U.S. Customer Service
Courtesy of Smith & Nephew, Inc., Endoscopy Division
All trademarks acknowledged.
©2013 Smith & Nephew, Inc. All rights reserved. 06/2013 00501-1
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