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The Post

My blog posts are always dependent on my mood and my experiences. Many times, they are the result of my connectedness to an experience or an ah ha moment. My posts also act as a reassurance to myself that all will be good. They are also a combination of encouragement for the mental attitude needed to be successful through your hip journey (and mine) And, sometimes, they include some practical information to aide you in your own patient education. I always hope that at least one of you can find something useful to apply to your own life and experiences.

The word, “post” is a verb and noun and has a multitude of uses. But, for today’s context, we are going to talk about a device that many hip surgeons are still using despite the significant complications that can cause long-term or, sometimes, permanent nerve damage. This contraption is called a perineal post.

Where does it go and what does it do? First of all, I had my first hip surgery 11 years ago and when it was described to me, my immediate wide eyed, jaw dropped question was, “You put what where?” So, doctors that are still using the perineal post put a large padded post between your legs, put your feet in boots and then apply the traction. So, envision that your feet are being pulled with a post between your legs with the end goal of getting your hip to distract so that the doctor can get the surgical instruments in your hip joint. Your perineum is taking the brunt of the pressure against that post.

Ouch, right? Yes, research shows that there is a much higher complication rate than you would want and, hopefully, your chosen surgeon would want. A recent article written by my very own Hip Healing Surgeon stated that there is approximately a 4.3% groin complication rate including “pudendal nerve palsy, impotence, and scrotal and labial tears” (Kollmorgen, Ellis, Lewis and Harris, 2019). From a patient perspective 4.3% does not sound that ominous until you are that patient with one of those complications. And it is completely unavoidable.

I have heard many patients develop these complications who did not know that there is an alternative to the perineal post. I have also heard patients who have said that their doctor knows about the option, but the hospital is not willing to pay for a new type of surgical table to decrease the negative outcomes. Let me tell you here and now. That is not an excuse.

The authors of “Achieving Post-Free Distraction in Hip Arthroscopy With a Pink Pad Patient Positioning Device Using Standard Hip Distraction Tables outline the use of a pink pad kit that allows you, as the patient, to be placed on a traditional hip table. In simple terms, your body sticks to the table and the traction is applied to your hips and your body does not move! There is no perineal post needed. The pad is pink, thus, the name “pink pad” and it feels like a memory foam mattress topper.

The other factor that doctors should consider is the cost of the pink pad. Kollmorgen, Ellis, Lewis and Harris indicate the cost is approximately $100. There is no need for an expensive new surgical table. There is a minimal learning curve for a surgeon to change his practice. There are no traction related complications. It is easier for the surgeon to complete a range of motion exam since there is no post to get in the way. Also, there is less pain post op as well. It’s a win-win for surgeon and patient. It is a win-win for hospital finances.

Although I am not a medical professional, I have had many hip surgeries with and without the perineal post over the course of 11 years. Hands down – my vote is to find a doctor who only uses postless distraction. If the doctor is not willing to look into this, then they are old school and probably not up to date with the current hip arthroscopy techniques. Run away. Find a hip preservationist on the ISHA website. Ask questions. Be informed. Keep hopeful.

Kollmorgen, R. C., Ellis, T., Lewis, B. D., & Harris, J. D. (2019). Achieving Post-Free Distraction in Hip Arthroscopy With a Pink Pad Patient Positioning Device Using Standard Hip Distraction Tables.Arthroscopy Techniques,8(4). doi: 10.1016/j.eats.2018.11.013

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