Pudendal symptoms after post-assisted hip arthroscopy are common and traction-dependent

Design

Prospective cohort, level 3

Population

93 adults undergoing primary hip arthroscopy with a perineal post

Primary outcome

Pudendal nerve palsy symptoms over 12 months

Effect

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

A prospective cohort followed 93 adults after primary unilateral hip arthroscopy with a perineal post, recording traction force and time with a sensor on the post, and asked confidentially about pudendal and sexual symptoms for a year. Published in the American Journal of Sports Medicine on 30 September 2026.

Early after surgery, 83% reported symptoms consistent with pudendal nerve palsy, most often perineal numbness. Urogenital or sexual dysfunction affected 39%, including erectile dysfunction in 22% of men. Symptoms persisted in 26% at three months and 14% at six months; all had resolved by a year. Each additional 10 minutes of traction raised the odds of symptoms (OR 1.59, 95% CI 1.12 to 2.37), and persistence beyond six weeks was linked to worse hip scores at six months.

This is a single cohort without a post-free comparison group, and the high rate partly reflects asking directly rather than waiting for patients to report. It gives surgeons figures to use in consent and a modifiable factor: traction time.

• Include pudendal numbness and temporary sexual dysfunction in consent for post-assisted hip arthroscopy
• Keep traction time as short as the procedure allows and release it when not needed
• Ask directly about perineal and sexual symptoms at follow-up; patients may not volunteer them
• Reassure that symptoms in this cohort had all resolved by a year
• Consider post-free distraction techniques where available

Why it matters

A complication that patients rarely report turned out to affect most of them when asked.

Don't overread it

A single cohort without a comparison group; it does not show post-free techniques are superior.

The statistics, in plain English

An odds ratio of 1.59 per 10 minutes means that, for example, 30 extra minutes of traction roughly quadruples the odds of symptoms. The wide interval on traction force (0.3 to 37 kg) means that link is less certain than the one with time.

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