The Arthrex® line of Limb Positioners provide safe, effective and easy positioning of the lower extremities during arthroscopic surgery. For more information, refer to our hip positioning products.

Product

An advanced limb positioning and distraction system for supine hip arthroscopy procedures with or without a perineal post, the Hip Distraction System (AR-6529S*) includes a patient table and pad, a patient prep platform and pad, two leg spars with traction boots, and a perineal post and pad. A pair of table clamps (based on the mating table rail) are also included. This next-generation hip distraction system features intuitive controls to facilitate preoperative patient setup and intraoperative changes in patient positioning. &nbsp;
The system is engineered out of carbon fiber, aluminum, and other lightweight, unyielding materials that provide maximum rigidity and minimal flex, ensuring distraction forces are maintained and reducing the overall weight for portability from storage to the operating room.&nbsp;
Identical teleTrac Carriages with gross and fine traction controls on the leg spars allow the fluid range of motion necessary during hip arthroscopy procedures. Hip flexion, extension, abduction, and adduction are controlled using the individual operating handles on the end of each spar. The novel traction boots with ratcheting straps provide the most secure and safe attachment for the patient's foot while minimizing heel lift and slip out.&nbsp;
*AR-6529S is sold with two HDS Traction Boot II, AR-6529-23

John Gualdoni (Group Product Manager, Hip Arthroscopy) reviews key features and benefits of the next-generation hip distraction boot for the Hip Distraction System. John demonstrates the proper placement of a patient’s foot and explains how to dismantle and clean the boot.

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Hip Distraction System Traction Boot II Product Demonstration

I'm John Baldoni, group product manager of hip arthroscopy at Arthrex. Today, I'll be running through the next generation Hip Distraction boot for our Hip Distraction system. I'll run through a few of the key features and benefits of this newly designed boot. I'll also run through how to properly place a patient's foot into the system. And lastly, I'll end with the proper dismantling and cleaning of the system at the end of the hip arthroscopy procedure. Next, I'd like to run through a few of the key features and benefits of this new hip distraction boot. The system is comprised of an outer shell construct with an instep pad for the top portion of the foot and shin, as well as a posterior pad to capture the calcaneus and Achilles during the foot placement of the procedure. If you look at the instep pad, the orientation of this pad is such that the Arthrex logo will always be at the top portion over top of where the shin is on the boot. You have four ergonomic ratchets that are designed to equally tension over top of the shin and the dorsal portion of the foot. You can see here you can simply disengage by pushing the inner button here and pulling up. That will disengage the instep ratchet from the strap. I'll do the same thing on the top portion here. I'll press this button and pull that up to disengage. Now my boot is ready for foot placement. For the procedure. When I'm completed this step, I will then put the foot into the system. I will simply take the ratchet strap, push that back into the ratcheting mechanism. I'll do that for all 2 or 4 sides, depending on how many sides you've taken off. Both are equal. You can take them off and put them back on as desired. And once I have all four straps into the ratchet, I will equally ratchet them down to adjust the tension over top of the foot. I'll start with one side, then the other. Work my way up to the top, ensuring that all four straps are equally tensioned into the instep pad for adequate placement and foothold during the procedure, if desired. At the start of the case, you can simply remove the instep pad by again pressing the black button here and pulling up on each of the instep pads, ratcheting portions to then completely detach and remove the instep pad from the system. You could then put the foot into the system here and then reattach the instep pad. Another key feature of this system is the posterior pad located on the shell of the boot. This pad is designed to capture the calcaneus and sit over top of the Achilles tendon. This, combined with the instep pad, will hold the ankle and foot during the procedure. There is a large cutout in the boot system to allow to sit at the bottom of the boot. This will allow the surgeon to see and view the heel to start of the procedure, as well as during the procedure. The heel to ensure that the calcaneus is still captured in this posterior pad when coupled with the instep pad during the procedure. Now I'll demonstrate how to properly place a patient's foot into the hip distraction boot. You'll notice the foot is completely wrapped in this blue foam pad for extra padding around the whole foot, as well as up to the shin on the patient. There's a nice cutout here and the bottom of the foot pad for the heel to be placed. You'll notice we have the boot completely flexed up to a maximum capacity. This will allow gravity as well as the weight of the patient's foot, to help us ensure that the calcaneus is placed all the way at the most posterior aspect of the boot, as well as the most distal aspect of the boot. It's important to ensure the heel is properly placed in the cutout in the bottom. We will then take the instep pad and place that over the top portion of the shin, as well as the top portion of the foot. Next, we'll take our straps and load those through the ratcheting And ensure it's through all four corners of the instep pad. As a reminder, the orientation for the pad is such that the Arthrex logo is always on top of the patient's shin when in the adequate position. Next, we'll incrementally ratchet each of these four ratchets to ensure that they capture the shin and foot of the patient. Once the desired tension is achieved, we'll do a quick finger check underneath the pad to ensure we have adequate placement of the instep pad. One final assessment can be performed to ensure the heel is properly placed in the most posterior and distal aspect of the boot in the opening here, after the foot has been properly placed into the boot. We will then unlock the key lever here, as well as the gross traction here, and slide the foot into a neutral position and slight internal rotation. To begin the procedure. To perform a range of motion check during the procedure. You can detach the boot from the carriage system by simply grasping the bottom of the boot and patients leg through the sterile drape. Putting your thumb over top of the carriage spa to press in the white button. Removing the boot from the spa. You can then do your range of motion check, and then simply reattach the boot back to the system by engaging that key on the bottom of the carriage spa, and again toggling back and forth until that click is heard on the white lever. To remove the posterior pad from the shell of the boot, either for cleaning after the procedure, or you can replace the reusable component if desired after multiple uses. You'll first detach the pad from the top triangle on the cutout here on the boot, and then remove the portion over the calcaneal opening. You'll see the posterior pad is completely detached now from the traction boot itself to reattach it to the system. You'll start with the lower portion of the triangle loaded through the lower portion of the triangle cutout on the shell. You'll then work your way up approximately on the boot toward the top portion of the triangle. And lastly, you'll take and hook the upper surface of the pad to the opening here on the cutout for the calcaneus. So first we'll take and place the triangular portion, the lower portion through the bottom of the boot itself with pulling and pushing the pad, working it through. Lastly, we'll take and push this portion of the pad over top of the cutout on the calcaneus opening on the shell.

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Hip Distraction System

John Gualdoni (Arthrex Product Manager, Knee and Hip Team) demonstrates the setup and use of the Hip Distraction System (HDS) for arthroscopic hip procedures. The system can easily be set up by one person with just a few steps.

Arthrex Hip Distraction System

The Arthrex Hip Distraction System is a lightweight, ergonomic lower limb positioning system that is designed for arthroscopic procedures of the hip. The system can easily be transported into the operating room using the storage cart, and attaches to most o.R beds via Clark Rail adapters. Begin assembly by attaching the right and left Clark rail adapters to each of the Clark railings on the bed. Bury the orange O-rings to ensure the adapters are adequately locked to the bed. Next, grasp the outer handles of the patient platform and adjust the platform width to match the bed before placing it into the Clark Rail Adapters. Pull the patient platform as well as well as the sliding metal post towards the operative side to allow for future engagement of the leg spars. Flip the reversible patient platform pad over so the opening is on the operative side to accommodate the perineal post and pad, and secure it to the platform with the Velcro straps. Attach the optional stabilizer leg to the middle of the patient platform to provide additional stability to the system. This leg attaches to the floor and can swivel to accommodate the C arm being brought in between the leg spars. Attach the well leg spar adapter to the non-operative side of the patient platform and lock it in place. Insert the well leg spar into the adapter at a 30 degree angle, and push it forward until it completely engages the adapter. Once engaged, lock it in place and slide the teletrack boot carriage distally so it's out of the way. Insert the operative leg spar into the patient platform at 30 degrees and then lock it in place. Attach the operative leg spar joint cover to the operative leg spar to help keep arthroscopic fluid from getting into the spar joint. Attach the universal traction boots to each of the leg spars. Insert the optional patient platform extender into the patient platform to provide a surface for the feet to rest during patient preparation. Unlock the lever at the base of each boot and flex them as high as possible and lock them in place. Loosen and slide the posterior ratchet distally to ensure the boot straps are loose for future foot placement. Unlock the buckles on all the straps and pads. And all the calcaneal pad as proximal as possible to ensure it will capture the foot above the calcaneus. Place the disposable blue foam pads on each of the patient's feet by following the printed instructions on the pads. This will ensure a full padding around the foot and ankle, with an opening to see the heel during the procedure, and monitor any heel lift off from the boot. With the prepped patient on the table, remove the patient platform extender and insert the detachable perineal post and pad on the operative side of the patient platform. Depress the silver button on the side of the post and push the black portion down towards the white arrows and insert the post at a 45 degree angle. Once fully locked in place. Put the perennial pad and disposable cover over the top of it. Unlock and slide the teletrack carriage towards the patient and place the padded feet into the traction boots. Place the instep pad above the ankle and lock the buckle in place. Apply some upwards pressure and use the posterior ratchet to cinch the instep and calcaneal pads together. Next, secure the proximal shin pad and lock the adjustable buckle in place. The toe pad will be secured after traction is applied. Squeeze the distal handle and manipulate the non-operative leg into adduction, and pull gross traction to equalize the pelvis. Once traction is applied to the operative leg, unlock the gross traction lever on the operative leg. Spa. Pull the flexion lever down and counterclockwise to unlock the flexion and extension gear at the proximal end of the operative spa. Squeeze the abduction handle and pull the leg into abduction with slight flexion to relax the hip capsule, pull gross traction and lock the leg in place. Swing the leg into deduction to create the vector force for hip joint distraction. Lock the leg in a neutral position by pulling the flexion lever laterally and swinging it down in a clockwise direction. Dial in the fine traction by twisting the fine traction knob clockwise. Lastly, internally rotate the foot and lock the toe pad buckle for added foot stability. Once work is completed in the central compartment and traction is no longer needed, remove the perineal post by depressing the metal button and pushing the plastic down towards the white arrows. Pull the perineal post and pad out and place off the surgical field. Remove the boot from the teletrack carriage and complete a range of motion assessment to ensure adequate cam resection and reattach the boot once complete. After completion of the hip arthroscopy, break down the components of the system and place them back in the storage cart.