The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post
Graeme Hoit, Tim Dwyer, Jaskarndip Chahal, Timothy A. Burkhart, Evan Curd, Shgufta Docter, Jordan Farag, John Theodoropoulos, Daniel B. WhelanBackground:
Pudendal nerve palsy (PNP) is a poorly characterized and underreported postoperative complication of hip arthroscopy (HA) with a perineal post. PNP may result in external genital numbness and sexual dysfunction in both men and women.
Purpose:
To describe the incidence, breadth, and duration of postoperative PNP symptoms and to evaluate the relationship between PNP and intraoperative limb traction.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
All patients underwent primary unilateral HA in a supine position with a perineal post. Patients with preexisting PNP symptoms, including sexual dysfunction, were excluded. Intraoperative traction duration and force were recorded using a sensor applied to the perineal post. A PNP screening questionnaire and validated sexual function questionnaires were administered confidentially at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Patient-reported hip outcomes (International Hip Outcome Tool–33 [iHOT-33]) were completed preoperatively and at 6 and 12 months.
Results:
A total of 93 patients were included (mean age, 36.4 years [SD, 9.2 years]; 55% male). The mean traction duration was 80 minutes (SD, 19 minutes). In the acute postoperative period, 77 (83%) patients experienced symptoms consistent with PNP. The most common symptoms were perineal numbness (75%), paresthesia (26%), and pain (18%). Urogenital or sexual dysfunction occurred in 39%, including erectile dysfunction in 22% of men and reduced sexual lubrication in 19% of women. At 3 months postoperatively, 26% of patients continued to have PNP symptoms, with 14% persisting to at least 6 months; all symptoms resolved by 12 months. Patients with PNP had greater traction force (MD, 18.1 kg; 95% CI, 0.3 to 37.1 kg) and longer traction time (MD, 15.4 minutes; 95% CI, 5.5 to 25.3 minutes). Longer traction duration was associated with increased odds of PNP (OR per additional 10 minutes, 1.59; 95% CI, 1.12 to 2.37). Persistence of symptoms beyond 6 weeks was associated with lower iHOT-33 scores at 6 months (MD, −14.4; 95% CI, −24.2 to −4.5).
Conclusion:
PNP symptoms were common after HA performed with perineal post traction, but most resolved within 6 months and all by 1 year. Increased traction duration and perineal pressure were significant predictors of symptom development, and persistent dysfunction correlated with lower hip-specific outcome scores.