HIGH RATES OF PUDENDAL NERVE PALSY AND SEXUAL DYSFUNCTION FOLLOWING TABLE TRACTION DURING HIP ARTHROSCOPY WITH A PERINEAL POST: PRELIMINARY RESULTS OF A PROSPECTIVE COHORT

Pudendal nerve palsy (PNP) is a poorly characterized but common postoperative complication of hip arthroscopy (HA) with a perineal post that can result in external genital numbness and sexual dysfunction in both men and women. Previous attempts to quantify the incidence of these symptoms have relied on patient-initiated reports, chart review, unvalidated questionnaires or have neglected the female experience all together – failures which likely underestimate the incidence of this complication. We aimed to describe the incidence of postoperative PNP, the breadth of symptoms patient experience and their duration, as well as establish the relationship between PNP and table traction. We utilized a multisurgeon prospective cohort of HA patients a single academic centre. All patients underwent primary unilateral hip arthroscopy, osteochondroplasty and labral repair in a supine position with a perineal post. Patients with pre-existing PNP symptoms, including sexual dysfunction, and those who were not sexually active were excluded. Intraoperative traction duration and force were recorded using a Tekscan sensor applied to the perineal post. A PNP screening questionnaire and standardized, validated sexual function questionnaires were administered confidentially to patients at 2-weeks, 6-weeks, 3-months and 6-months postoperatively. Patient reported hip function scores (iHOT-33) were completed preoperatively and at 6-months postoperatively. The initial 83 cohort patients with 6-month follow-up were included in this preliminary analysis. Thirty-six patients (43%) were female with a mean age of 37+14 years and BMI of 24+3kg/m2. The mean traction duration was 81+19 minutes. Sixty-three patients experienced symptoms consistent with PNP in the acute postoperative period (75%). The most common sensory symptom described was perineal numbness (n=62, 75%), followed by paresthesia (n=22, 27%). Thirteen men (28%) and thirteen women (36%) reported symptoms of sexual dysfunction postoperatively, in the form of erectile dysfunction (men) or reduced sexual lubrication/dyspareunia/anorgasmia (women). Of patients who experienced PNP symptoms (n=63), 20% had symptoms resolve by 2 weeks, 60% by 6 weeks, 86% by 3 months, and 98% by 6 months postoperatively. The one patient whose symptoms persisted beyond 6 months reported persistent erectile dysfunction. Persistence of PNP symptoms beyond 6 weeks was associated with lower iHOT33 scores at 6 months (mean difference: 18.4 [95%CI: 6.5–30.4], p=0.003). Analysis of the calibrated sensor data to establish the relationship between traction force, pressure and duration with PNP is pending. In this preliminary analysis of a planned 100 patient cohort, patients experienced a high rate of PNP and sexual dysfunction symptoms following HA with perineal post, far higher than previous reports. The vast majority of symptoms resolved within the first 3-months post-operatively. Anticipated results from the sensor data within this ongoing study are likely to provide insight into the relationship between traction force and/or duration and PNP incidence. A post-less HA setup could be considered as an alternative given the described morbidity.