FP2.5 Does the Addition of a Traction Pad Reduce the Rate of Postoperative Pudendal Neuralgia in Hip Arthroscopy: Interim Analysis of a Randomized Controlled Trial

Background: Transient pudendal neuralgia is the most frequently described complication following hip arthroscopy. Traction pads are theorized to reduce postoperative pudendal neuralgia when using a perineal post. The present study is the first randomized controlled trial assessing pudendal neuralgia with and without the use of a traction pad among patients undergoing hip arthroscopy with a perineal post.

Methods: Adult patients undergoing hip arthroscopy at a single institution were prospectively enrolled in this pre-registered trial. Block randomization was performed to either perineal post alone or perineal post plus a traction pad. All patients completed ordinal questionnaires (not at all, mild, moderate, severe) regarding saddle numbness, difficulty with urination or bowel movements, skin changes, and sexual dysfunction at baseline, two hours, seventy-two hours, one week, three weeks, and six weeks postoperatively. Outcomes were compared at each time point using ordinal logistic regression models. A predetermined alpha of 0.05 was used to assess statistical significance. An interim analysis of the first fifty-three patients was performed due to anecdotal concerns that failure to use a traction pad led to undue patient harm.

Results: Among the first fifty-three patients enrolled in this trial, 26 and 27 patients were randomized to the traction pad and control groups, respectively. Average age and gender distribution were similar across the two groups (40.2 years in the traction pad group vs 37.1 years in the control group (p=0.31) and 24% male versus 34.6% male, p=0.60). We did not find a statistically significant association between use of a traction pad and any of our outcomes at any time point. The overall rate of experiencing any adverse outcome at any time point was 94.4%.

Conclusion: This study is the first randomized controlled trial of neurologic outcomes following hip arthroscopy with concomitant use of a perineal post and a traction pad. In conjunction with the high overall rate of any adverse outcome at any time point, these interim results suggest that use of a traction pad does not mitigate the adverse effects of a perineal post during hip arthroscopy. Our findings highlight the benefits of moving away from use of a perineal post toward post-less surgery.