[Clinical efficacy of a perineal post-free traction technique in the Trendelenburg position on enhanced recovery following hip arthroscopic surgery in patients with femoroacetabular impingement].

Objective: To evaluate the impact of perineal post-free traction in the Trendelenburg position on enhanced recovery after hip arthroscopy in patients with femoroacetabular impingement (FAI). Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopy for FAI at the First Medical Center of the PLA General Hospital between September 2023 and September 2024. Patients were divided into two groups: a control group (traditional traction, n=80) and an enhanced recovery group (Trendelenburg position with perineal post-free traction, n=80). Intraoperative data, including operative time, traction time, Trendelenburg angle, and traction force, were recorded. Clinical outcomes were assessed using the modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12), and the visual analogue scale (VAS) for pain, administered preoperatively and at 3 days and 4 weeks postoperatively. Postoperative limb numbness was evaluated using the numeric rating scale (NRS), VAS scores, and time to resolution. Additional outcomes included the incidence and resolution time of perineal complications, skin injuries, analgesic consumption, length of hospital stay, and patient satisfaction. Results: A total of 160 patients were included, comprising 94 males and 66 females with a mean age of (39.9±14.3) years. The control group included 49 males and 31 females with a mean age (40.5±13.3) years, while the enhanced recovery group included 45 males and 35 females with a mean age of (39.3±15.1) years. No significant differences was observed between the control group and the enhanced recovery group in terms of operative time [(78.73±15.45)  vs (79.53±13.28) min] or traction time [(35.50±8.36) vs (37.58±10.66) min] (both P>0.05). At both 3 days and 4 weeks postoperatively, mHHS, iHOT-12 and VAS scores exhibited significant improvement when compared to those preoperative values in both groups (all P<0.001), but with no significant differences between groups (all P>0.05). However, the enhanced recovery group demonstrated significantly better outcomes than the control group in terms of postoperative NRS of numbness [(1.32±0.53) vs (3.22±1.14) points], VAS of numbness [(2.52±1.53) vs (5.51±1.52) points], resolution time of numbness [(2.51±1.52) vs (3.51±1.53) days], incidence of perineal complications [0 vs 5.0%(4/80)], incidence of skin injury [3.8%(3/80) vs 8.8%(7/80)], postoperative analgesic use [(50.25±17.75) vs (75.25±12.25) mg], length of hospital stay [(3.23±0.52) vs (4.23±1.52) days], and patient satisfaction scores [(98.23±1.03) vs (90.12±5.16) points] (all P<0.05). Conclusion: The Trendelenburg position with perineal post-free traction technique provides FAI patients with comparable intraoperative efficacy to traditional traction methods while significantly enhancing postoperative recovery outcomes in patients undergoing hip arthroscopy.