Editorial Commentary: Postless Hip Arthroscopy May Help Optimize Outcomes, but Use of a Post Is Acceptable and Is Indicated in Select Cases.

Compared with postless arthroscopy, hip arthroscopy using a perineal post (post-assisted traction) is associated with increased risk of complications in 1% to 30% of patients, including pudendal neuropraxia (sexual dysfunction, dyspareunia, perineal pain, and/or numbness) and perineal soft-tissue injuries (vulvar bruising, tears, or scrotal swelling). Although these groin-related complications are usually transient in nature, they are significant and should be prevented if at all possible. Because of the sensitive nature of groin-related injuries after surgery, these complications also can go unrecognized by surgeons, which may result in underappreciation of their true prevalence. In contrast, postless distraction can be performed safely and eliminate the risk of perineal-related complications associated with a perineal post. In addition, dynamic evaluation during cam resection is aided by postless techniques and allows for greater and unimpeded hip range of motion compared with motion restriction with the use of a post. Postless hip arthroscopy is an emerging standard for hip arthroscopy surgery, but there are select instances in cases of challenging access to the hip joint for which a post may still have utility. Indications for use of a post could be patients with high body mass index, men with decreased hamstring flexibility, and patients with lower Beighton scores and greater hip stiffness, because if access to the joint is challenging, a perineal post may allow for greater distraction. Of importance, if a perineal post is used, care should be taken toward limiting traction time, as prolonged traction has been shown to be a major risk factor associated with post-related groin complications. In addition, the Trendelenburg position decreases the contact force against the perineal post. Finally, converting from a post-assisted technique to a postless system has a short learning curve for surgeons.