The edition · Orthopaedics
Pudendal symptoms follow most post-traction hip arthroscopies
A prospective cohort finds 83% of patients had pudendal nerve symptoms after hip arthroscopy with a perineal post, rising with traction time; PRP shows no consistent structural effect in knee osteoarthritis; and local antibiotic carriers in arthroplasty are compared.
The edition in brief
A prospective cohort of 93 patients undergoing hip arthroscopy with a perineal post found 83% had pudendal nerve palsy symptoms early after surgery, including sexual or urogenital dysfunction in 39%; symptoms persisted beyond six months in 14% and resolved in all by a year. Each extra 10 minutes of traction raised the odds of palsy by about 60%. A meta-analysis of 12 randomised trials found platelet-rich plasma did not consistently change MRI structural outcomes in knee osteoarthritis, with isolated signals for patellofemoral cartilage and bone marrow oedema. A meta-analysis of 17 mostly observational studies found an antibiotic-loaded hydrogel coating was associated with lower periprosthetic joint infection rates than calcium sulfate beads or antibiotic cement, though the evidence is low quality.
PRP in knee osteoarthritis: no consistent effect on joint structure
Tell patients considering PRP for knee osteoarthritis that it has not been shown to protect or rebuild cartilage.
Local antibiotic carriers in hip and knee arthroplasty: a hydrogel coating leads, on weak evidence
Worth considering a local antibiotic carrier in high-risk or revision arthroplasty; the evidence does not justify routine use in primary cases.
Three PJI prevention steps that need no new product
Get the timing of prophylaxis and preoperative optimisation right before adding newer local antibiotic products.
Pudendal nerve palsy after hip arthroscopy is common — consent for it and watch the traction clock
Consent for pudendal symptoms before post-assisted hip arthroscopy, minimise traction time, and ask about them at every follow-up.
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