Pudendal nerve palsy after hip arthroscopy is common — consent for it and watch the traction clock

Design

Prospective cohort with intraoperative traction sensor

Population

93 adults undergoing primary hip arthroscopy with a perineal post

Primary outcome

Incidence and duration of pudendal nerve palsy symptoms

Effect

83% early symptoms; 14% at 6 months; OR 1.59 per 10 min traction (1.12–2.37)

This prospective cohort followed 93 patients having primary hip arthroscopy, supine, with a perineal post. A sensor recorded traction force and time, 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 (75%). Sexual or urogenital dysfunction affected 39%, including erectile dysfunction in 22% of men. Symptoms persisted in 26% at three months and 14% at six months, and all had resolved by 12 months. Each additional 10 minutes of traction increased the odds of palsy (OR 1.59, 95% CI 1.12–2.37), and symptoms lasting beyond six weeks were associated with worse hip scores at six months.

This is a single cohort with confidential questioning, which probably explains why the rate is far above what surgeons usually report. It supports explicit consent for pudendal symptoms, keeping traction time as short as the procedure allows, and asking directly about them at follow-up.

• Include perineal numbness and temporary sexual dysfunction in consent for post-assisted hip arthroscopy.
• Track traction time and release traction whenever it is not needed.
• Ask about pudendal and sexual symptoms directly at follow-up; patients rarely volunteer them.
• Reassure that symptoms resolved in all patients by a year in this cohort.
• Consider post-less distraction techniques where available.

Why it matters

A complication thought to be rare turns out to affect most patients when they are asked privately.

Don't overread it

One cohort with a perineal post; rates may differ with post-less traction systems.

The statistics, in plain English

An odds ratio of 1.59 per 10 minutes means that 30 minutes of extra traction roughly quadruples the odds of palsy (1.59 × 1.59 × 1.59). With 93 patients the estimates are imprecise, but the direction is consistent across force and time.

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