Introduction: Hip arthroscopy is a commonly performed procedure that carries a notable risk of nerve injury secondary to port placement and the use of axial traction. Sensory neurapraxia of the pudendal nerve and the lateral femoral cutaneous nerve is most common; however, sexual dysfunction and sciatic nerve injury has also been reported. Reported incidence of nerve injury ranges between 1.4% and 5% in the literature, but much of these data are based on unsolicited patient concerns. This study aimed to determine the true rate of nerve injury among this patient population through administration of a validated survey at multiple time points.
Methods: A prospective study of all patients undergoing hip arthroscopy requiring traction by a single surgeon at our institution was performed. These cases were the first 100 hip arthroscopies performed in practice by the surgeon. Before surgery, all patients were asked about the presence of neuropathic symptoms including sexual dysfunction through administration of a validated questionnaire. The same questionnaire was then administered at several time points postoperatively: on the day of surgery, on postoperative day 2, at the first follow-up visit, and if symptoms persisted, then at each follow-up appointment until resolution of the symptoms. Overall incidence of nerve injury was then calculated. Subgroup analyses were performed to investigate whether traction time, sex, body mass index (BMI), or technically demanding surgical skills affected the incidence.
Results: This study included a total of 100 patients with an average age of 29 (13 to 62) years and an average BMI of 25. Nerve injury was seen in 13 patients with an incidence of 13%. Specific nerves injured included the pudendal (9), lateral femoral cutaneous (2), sciatic (1), and superficial peroneal nerves (1). Subgroup analysis did not demonstrate a notable association between the risk of nerve injury and increased traction time, sex, or increased BMI. The technically demanding surgical skills was associated with a notable decrease in the traction time, but no notable difference in the risk of nerve injury was observed. Most nerve injuries resolved within 2 weeks (8 of 13), and all cases of nerve injury resolved within 9 months.
Discussion and conclusions: The incidence of nerve injury after hip arthroscopy may be markedly higher than previously reported; however, resolution seems to occur as previously found in the literature. Patients should be educated regarding the risk of nerve injury during this procedure.
Level of evidence: Level IV.