Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review

Abstract

Introduction: Pudendal nerve neurapraxia is a classic complication after traction on the fracture table. Diagnosis, however, is difficult and often overlooked, especially after arthroscopy in traction on fracture table; incidence is therefore not known exactly.

Hypothesis: The study hypothesis was that incidence of pudendal nerve neuropathy exceeds 1% after hip arthroscopy.

Materials and methods: Results for 150 patients (79 female, 71 male) undergoing hip arthroscopy between 2000 and 2010 were analyzed retrospectively. The principal assessment criterion was onset of pudendal neuralgia. Secondary criteria were risk factors (history, surgery time, type of anesthesia), associated complications, onset to diagnosis interval and pattern of evolution.

Results: At a mean 93 months' follow-up, there were 3 cases (2 women, 1 man) (2%) of pure sensory pudendal neuralgia; 2 concerned labral lesion resection and 1 osteochondromatosis. Surgery time ranged from 60 to 120min, under general anesthesia with curarization. Time to diagnosis was 3 weeks. No complementary examinations were performed. Spontaneous resolution occurred at 3 weeks to 6 months. No significant risk factors emerged.

Conclusion: The present study found 2% incidence of pudendal neuralgia, with no risk factors emerging from analysis. Prevention involves limiting traction force and duration by using a large pelvic support (diameter>8-10cm). Patient information and postoperative screening should be systematic.

Level of evidence: Level IV. Retrospective study.

Keywords: Complication; Fracture table; Hip arthroscopy; Neurapraxia; Pudendal nerve.