The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post
6 affiliations
- 1Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- 2Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- 3University of Toronto Orthopaedic Sports Medicine, University of Toronto, Toronto, Ontario, Canada
- 4Division of Orthopaedic Surgery, Women’s College Hospital, Toronto, Ontario, Canada
- 5Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada
- 6Department of Physiatry and Rehabilitation Medicine, University of Toronto, Toronto, Ontario, Canada
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 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.
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BibTeX
@article{hoit2026incidence,
title = {{The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post}},
author = {Graeme Hoit and Tim Dwyer and Jaskarndip Chahal and Timothy A. Burkhart and Evan Curd and Shgufta Docter and Jordan Farag and John Theodoropoulos and Daniel B. Whelan},
journal = {The American Journal of Sports Medicine},
year = {2026},
month = sep,
doi = {10.1177/03635465261485701},
url = {https://doi.org/10.1177/03635465261485701},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post
AU - Graeme Hoit
AU - Tim Dwyer
AU - Jaskarndip Chahal
AU - Timothy A. Burkhart
AU - Evan Curd
AU - Shgufta Docter
AU - Jordan Farag
AU - John Theodoropoulos
AU - Daniel B. Whelan
PY - 2026
DA - 2026/09/30
JO - The American Journal of Sports Medicine
DO - 10.1177/03635465261485701
UR - https://doi.org/10.1177/03635465261485701
AB - 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 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.
SN - 0363-5465
SN - 1552-3365
ER -