Traction-related urinary complications in hip arthroscopy using a perineal post: Prevalence, risk factors, and...

Femoroacetabular impingement syndrome (FAIS) is a leading cause of chronic hip pain in young adults, often treated with hip arthroscopy. While effective, the procedure involves traction with a perineal post that can impact the urogenital system. This study aims to evaluate urinary function changes in patients undergoing hip arthroscopy for FAIS.

Urinary functions of the operated patients would be affected by the surgical procedure in the short term, but the symptoms would resolve within the first year MATERIALS AND METHODS: A retrospective cohort study was conducted on patients who underwent hip arthroscopy with a perineal post for FAIS between March 2017 and May 2022. Inclusion criteria were patients aged 18-50 with consistent physical and radiological findings of FAIS, who had failed non-surgical treatments, and had complete preoperative, postoperative, and one-year follow-up data. Patients with pre-existing conditions affecting urinary function were excluded. The study included 118 patients who completed the International Incontinence Consultation Questionnaire (ICIQ). Data on demographic variables, surgical details, and urinary symptoms were collected and analyzed. Urinary functions were assessed using the Female and Male Lower Urinary Tract Symptoms Questionnaires (ICIQ-FLUTS and ICIQ-MLUTS), and clinical outcomes were measured with the modified Harris Hip Score (mHHS).

The study cohort had an average age of 38.1 ± 8.3 years, with 54% being female. The average operation time was 145.9 ± 17.9 min, and the average traction time was 74.6 ± 16.1 min. Pudendal nerve irritation was observed in 13 patients postoperatively, resolving within the first year. Correlation analysis revealed that filling, voiding and incontinence function scores were positively correlated with traction time (p = 0.002, p < 0.001, p = 0.004, respectively) and total operation time (p = 0.002, p < 0.001, p = 0.001, respectively). In men, significant deterioration in voiding and incontinence functions was observed at four months postoperatively, and this improved at one year. Women showed no significant changes in urinary function scores postoperatively. Higher body mass index (BMI) was associated with increased incontinence scores.

Arthroscopic surgeries for FAIS with a perineal post have been observed to have significant effects on urinary functions, especially in male patients. These findings emphasize the importance of considering urinary functions in the planning of the surgical process. Additionally, it is important to inform patients about these potential issues. Future studies will provide more information on the prevention and management of these complications.

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