EP225 Female Patients Achieve Adequate Working Space for Hip Arthroscopy at Less Force than Male Patients: An in vivo Traction Analysis

Abstract Introduction Prior research has established that 10mm of distraction is required for appropriate instrumentation during hip arthroscopy and that female patients distract easier than male patients. However, the amount of force required in these two patient populations to achieve adequate distraction has not been quantified. We hypothesized that female patients would achieve 10mm of distraction with less force than male patients. Methods Patients from February 2022 to February 2025 who underwent primary hip arthroscopy for the treatment of femoroacetabular impingement were reviewed. All patients underwent an intraoperative traction exam after induction of general anesthesia on a post-free traction table and prior to instrumentation, which included applying axial traction to the hip in 25-pound force intervals up to 100 pounds of force. Patients were excluded if they did not break their suction seal without venting at 100 pounds, if they had dysplasia or pincer morphology, and if they had an incomplete traction exam. Joint space was calculated as the distance between the lateral edge of the sourcil in a straight line to the femoral head on fluoroscopy. Results A total of 284 patients were included, with 60.2% being female and a mean age of 31.1 ± 12.5 years. No male patients achieved 10mm of distraction with less than 75 pounds of force, with 82.3% requiring 100 pounds of force; 70.8% of female patients achieved 10mm of distraction with 75 pounds of force or less, with 57.7% requiring 75 pounds of force. Female patients achieved a greater mean distraction distance when compared to male patients at 100 pounds (13.7 ± 2.2 vs 11.4 ± 1.9 mm; p<0.001). Conclusions Female patients require less force to achieve optimal working space for hip arthroscopy in a post-free traction system. This should be considered when performing hip arthroscopy and care taken to avoid excessive traction and its associated sequelae such as sciatic/pudendal nerve palsy and soft tissue pressure injury to the groin. Once adequate distraction is achieved, surgeons should consider reducing traction while maintaining optimal working space for the duration of surgery.