Hip arthroscopy with a post: counsel on pudendal symptoms, limit traction time

Design

Prospective single-centre cohort

Population

93 adults having primary hip arthroscopy with a perineal post

Primary outcome

Pudendal nerve palsy symptoms over 12 months

Effect

83% early, 14% at 6 months, 0% at 12 months; OR 1.59 per 10 minutes traction (95% CI 1.12 to 2.37)

A prospective Canadian cohort in the American Journal of Sports Medicine (30 September) followed 93 patients after primary hip arthroscopy in the supine position with a perineal post. A sensor on the post recorded traction force and duration, and patients completed confidential questionnaires on pudendal and sexual symptoms for a year.

Early after surgery, 83% had symptoms consistent with pudendal nerve palsy, most often perineal numbness. Urogenital or sexual dysfunction affected 39%, including erectile dysfunction in 22% of men and reduced lubrication in 19% of women. Symptoms were still present in 26% at three months and 14% at six months, and all had resolved by a year. Each extra 10 minutes of traction raised the odds by about 59% (OR 1.59), and those with symptoms beyond six weeks had worse hip scores at six months.

Pudendal symptoms are rarely raised in consent and, because patients seldom volunteer them, routine follow-up underestimates them. This study supports naming them in the consent discussion, asking directly afterwards, and keeping traction time as short as possible. Postless techniques avoid perineal pressure and are being tested in trials, but this study did not compare them.

• Include pudendal numbness and temporary sexual dysfunction in consent for post-assisted hip arthroscopy.
• Ask directly about perineal numbness and sexual function at follow-up, since patients rarely volunteer them.
• Keep traction duration as short as possible and release traction when not needed.
• Reassure patients that symptoms resolved in everyone by one year in this cohort.
• Consider a postless technique where available, recognising it was not tested here.

Why it matters

A complication most patients experienced is barely mentioned in usual consent, and it is linked to something the surgeon controls.

Don't overread it

This single-centre cohort shows association with traction time, not that shortening traction prevents symptoms.

The statistics, in plain English

An odds ratio of 1.59 per 10 minutes means each additional 10 minutes of traction multiplied the odds of symptoms by about 1.6. The confidence interval (1.12 to 2.37) excludes no effect. With 93 patients, the exact percentages are estimates with some uncertainty.

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