Improved Limb Positioning and Hip Access During Hip Arthroscopy With Articulated Traction Device  Omer Mei-Dan, M.D., Mark O. McConkey, M.D., David A. Young, F.R.C.S.  Arthroscopy Techniques  Volume 2, Issue 1, Pages e51-e54 (February 2013) DOI: 10.1016/j.eats.2012.10.009 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A, B) The foot is placed in a traction ski-type boot attached to a Spider articulated hip traction system. The articulated traction unit is positioned such that the hinge is directly in line with the leg and as far distal from the patient's body as possible. Manual traction is applied to the leg by sliding the post to which the Spider unit is attached distally along its track or traction arm. Further incremental traction is applied by turning the crank, located at the base of the boot. (C) Operating room setup with Spider arm in use for hip traction. Arthroscopy Techniques 2013 2, e51-e54DOI: (10.1016/j.eats.2012.10.009) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A-D) The surgeon can flex, internally or externally rotate, adduct, or abduct the leg into any position desired, limited only by the patient's anatomy and the position of the post (for adduction). Arthroscopy Techniques 2013 2, e51-e54DOI: (10.1016/j.eats.2012.10.009) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 Right hip arthroscopy with articulated traction device. The viewing portal, hours on a clock face, and hip positions are indicated. The position on the neck/head in terms of hours on the clock face for a right hip would be 12 o'clock–3 o'clock–6 o'clock for anterior and 12 o'clock–9 o'clock–6 o'clock for posterior. (A) View of anteroinferior cam lesion. (MSF, medial synovial fold.) (B) Posteroinferior view. (FABER, flexion–abduction–external rotation; Mid-Ant, mid anterior.) (C) View of inferior (5 o'clock) resected cam lesion. (ER, external rotation; Mid-Ant, mid anterior.) (D) View of posteroinferior aspect of femoral head from below (from 6 o'clock/calcar up to 9 o'clock). (FABER, flexion–abduction–external rotation; jun, junction; Mid-Ant, mid anterior; pos, posterior.) Arthroscopy Techniques 2013 2, e51-e54DOI: (10.1016/j.eats.2012.10.009) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions