Previous studies have demonstrated rates of perineal nerve and/or soft tissue complications as high as 46% following hip arthroscopy. Recently, the use of the Trendelenburg position and a post-less hip distraction setup has shown early promising outcomes with no reported groin-related complications. The purpose of this study was to compare groin-related nerve and soft tissue complications between patients undergoing hip arthroscopy with versus without the use of a perineal post.
A prospective, single-surgeon cohort study was performed on all patients undergoing hip arthroscopy by the senior author between January 2020 and January 2021. The Pivot Guardian, post-free hip distraction system (Stryker, Kalamazoo, MI) was used at one center at which the senior author operates, and a Hana table (Mizuho, Union City, CA) with a perineal post (Smith & Nephew, Andover, MA) was used at another surgical location. A survey was completed by each patient at the first postoperative visit (7-10 days postoperatively) to determine if the patient had experienced any groin-related complications following surgery. These included groin numbness, sexual dysfunction, urinary dysfunction, and skin tears. For any patients with a positive survey response, the survey was repeated at each follow-up visit (6 weeks, 3 months, 6 months) until the symptoms resolved. The rate and duration of groin-related complications was then compared between the two groups. Independent samples t-tests were performed to compare continuous variables while chi-squared tests were performed to compare categorical variables.
A total of 43 patients were included in the study, 31 of whom underwent hip arthroscopy with a perineal post and 12 patients without a perineal post. No differences were found between the post and post-less groups in terms of age at surgery (33 ± 14 vs 26 ± 10 years, p = 0.112), sex (52% vs 50% female, p = 0.9243), or body mass index (26 ± 6 vs 28 ± 8, p = 0.343). In addition, average traction time did not significantly differ between the groups (post: 55 ± 18, post-less: 50 ± 11 minutes, p= 0.504). The average Trendelenburg angle among the post-less patients was 12° (range 10-14°). We found that 8 (26%) patients in the perineal post group experienced groin numbness versus 0 (0%) in the post-less group (p=0.049). On average, groin numbness lasted 5 ± 4 days in the perineal post group. We also found that 4 (13%) patients in the perineal post group experienced groin pain versus 2 (17%) in the post-less group (p=0.244). One patient in the perineal post group experienced sexual dysfunction for 5 days. Seven (23%) patients in the perineal post group experienced foot numbness versus 1 (8%) in the post-less group (p=0.168). One patient in the perineal post group experienced foot numbness for 157 days. Six others from the perineal post group also experienced foot numbness which averaged 6 ± 4 days vs 2 days for one patient in the post-less group (p=0.842). Finally, no skin tears were reported in either groups.
In recent years, efforts have been made to decrease perineal complications among hip arthroscopy patients by adjusting intraoperative positioning and setup. Our study demonstrated fewer perineal complications among patients who underwent hip arthroscopy without a perineal post. However, larger studies are warranted to corroborate these findings.