EP3.18 Hip arthroscopy with a perineal post results in high incidence of pudendal nerve palsy in both men and women - a prospective cohort study

Abstract Background 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 intra-operative limb traction. Methods A prospective cohort of patients undergoing primary unilateral HA in a supine position with a perineal post was a assembled. Patients with pre-existing PNP symptoms, including sexual dysfunction were excluded. Intraoperative traction duration and force was recorded using a Tekscan 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 (iHOT-33) were completed preoperatively and at 6 and 12 months. Results Ninety-three patients were included (mean age 36.4+9.2 years; 55% male). Mean traction duration was 80+19 minutes. In the acute postoperative period, 77 patients (83%) 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 18.1kg [95%CI:0.3-37.1]) and longer traction time (MD 15.4 minutes [95%CI:5.5-25.3]). Longer traction duration was associated with increased odds of PNP (OR 1.59 per additional 10 minutes [95% CI:1.12-2.37]). Persistence of symptoms beyond 6 weeks was associated with lower iHOT33 scores at 6-months (MD -14.4 [95%CI:-24.2--4.5]). Conclusion PNP symptoms were common in both men and women after HA performed with perineal post traction. Increased traction duration was associated with PNP, and persistent symptoms correlated with worse hip-specific outcomes. These findings emphasize the importance of minimizing traction exposure and considering postless or low-traction approaches to reduce postoperative morbidity.