EP1.14 Surgical technique video for Combined Hip Arthroscopy and Derotational Femoral Osteotomy on a Postless Traction Bed

Abstract Abnormal femoral torsion is a well-recognized contributor to hip pain, labral and chondral injury, and early-onset osteoarthritis. Physiologic femoral antetorsion ranges from 15–20 degrees. Deviations from this range, including retrotorsion and excessive antetorsion, alter hip joint biomechanics and increase articular stress. When pathological femoral torsion is identified, derotational femoral osteotomy (DFO) remains the surgical treatment of choice to restore normal torsional alignment, optimize joint mechanics, and improve clinical outcomes. DFO is frequently performed in conjunction with hip arthroscopy (HA) to address associated intra-articular pathology, which requires safe and reliable hip joint distraction. Traditionally, combined HA and DFO have been performed using perineal post traction beds. Although effective, these systems are associated with complications including groin injury, pudendal nerve palsy, genital soft tissue damage, and interference with intraoperative imaging, and they often do not allow both procedures to be performed within the same operative setup. In response to these limitations, postless traction beds were developed to mitigate these risks while offering several technical and workflow advantages. Compared with traditional perineal post traction beds, the postless traction system provides controlled traction and stable femoral positioning before and after osteotomy, facilitating precise distal fragment manipulation, incremental rotational correction, and secure fixation. Elimination of the perineal post allows unobstructed fluoroscopic imaging with efficient acquisition of anteroposterior and lateral views, minimizing C-arm repositioning and operative time while avoiding post-related complications. This video demonstrates the surgical technique for combined HA and DFO using a postless traction bed (Pivot Guardian Distraction System, Stryker, Inc.), as well as its application for isolated DFO. The technique allows a seamless transition between HA and DFO within the same operative setup, improving workflow and operative efficiency. The video highlights key technical steps, patient positioning strategies, and intraoperative pearls for achieving accurate femoral torsional correction while maintaining stability and visualization. Learning objectives include understanding the indications for combined HA and DFO, mastering patient positioning and traction techniques using a postless system, and recognizing the workflow, imaging, and safety advantages of this approach. This technique provides a safe, reproducible, and efficient solution for patients requiring DFO with or without HA