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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".