Risk factors for insufficient hip distraction for safe central compartment access during hip arthroscopy: retrospective analysis of 677 cases.

Sufficient hip distraction is crucial for the assessment of the central compartment in hip arthroscopic surgery. The aim of this study was to identify the risk factors linked to insufficient hip distraction during hip arthroscopic surgery. We hypothesized that the presence of pincer- or mixed-type femoroacetabular impingement (FAI) could hinder effective hip distraction during the procedure. Inclusion criteria included indication for hip arthroscopy, and persistent symptoms that have not responded to extensive conservative treatment, such as activity adjustments and physical therapy over a period of 6-12 weeks. The enrollment period spanned from January 2003 to May 2021. Data on age, sex, diagnosis of FAI, body mass index, body height, body weight, lateral center-edge angle (LCEA), hip joint space, Tönnis grading, and Beighton score were collected. Among the cases, 34 had insufficient hip distraction while 643 did not. Crude odds ratio analysis revealed that male gender, body height, increased LCEA, the presence of pincer- or mixed-type FAI, and a lower Beighton score were associated with a higher risk of insufficient distraction. Further analyses confirmed that only FAI, sex, and Beighton score remained significant predictors of risk. Adjusted odds ratios indicated a strong association with pincer- or mixed-type FAI. The presence of pincer- or mixed-type FAI is identified as a risk factor for insufficient hip distraction during hip arthroscopic surgery. In high-risk patients, adopting a peripheral compartment approach initially and avoiding hip traction can help prevent traction-related complications.