Purpose
To investigate the site of pudendal nerve compression and the relation between traction
force and abduction angle regarding pressure levels at setup for hip arthroscopy.
Methods
A total of 17 hips from 9 fresh-frozen cadavers (6 male and 3 female cadavers) were
used. The pudendal nerves were dissected, and 3 FlexiForce force sensors (Tekscan,
Boston, MA) were implanted on the pudendal nerve where the inferior rectal nerve,
perineal nerve, and dorsal nerve of the clitoris/penis emerge. A custom-made traction
table in a supine position was used with a padded perineal post of 9 cm. Recordings
were made at 0, 10, 20, 30, and 40 kg of traction at varying hip abduction angles
of 0°, 15°, 30°, and 45°.
Results
The tuber ischiadicum (perineal nerve) and genital region (dorsal nerve of penis/clitoris)
had statistically higher pressure values when compared with the pudendal canal (inferior
rectal nerve) (P < .05). There was a significant increase in forces acting on the pudendal nerve with
increasing application of 0 to 40 kg of traction in steps of 10 kg, with the exception
of the pudendal canal sensor and reading of the perineal nerve sensor at 45° of hip
abduction (P < .004 with Bonferroni correction for significant values). On the contrary, hip abduction
angle had no statistically significant effect on pudendal nerve compression. (All
specific P values with Bonferroni correction were greater than .003.)
Conclusions
To avoid nerve palsy completely, the etiopathogenesis of compressive neuropathy should
be identified. The location for compression and relation between different traction
positions and forces are clarified in this study. This information can be used for
further research and prevention.
Clinical Relevance
This study adds objective data on the etiopathogenesis of pudendal nerve compression,
which potentially contributes to prevention of pudendal nerve palsy as a common complication
of hip arthroscopy.
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References
- Complication of hip arthroscopy: Analysis of seventy three cases.Chang Gung Med J. 2006; 29: 86-92
- Complications of arthroscopic surgery of the hip.Bone Joint Res. 2012; 1: 131-144
- Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.Arthroscopy. 2013; 29: 589-595
- Complications of hip arthroscopy.Clin Sports Med. 2001; 20: 831-835
- Hip arthroscopy technique and complications.Orthop Traumatol Surg Res. 2010; 96: S68-S76
- Pudendal nerve palsy in trauma and elective orthopaedic surgery.Injury. 2013; 44: 1721-1724
- Hip arthroscopy in adults.Bull NYU Hosp Jt Dis. 2010; 68: 97-102
- Hip arthroscopy by the lateral approach.Arthroscopy. 1987; 3: 4-12
- Hip arthroscopy without traction.in: Byrd J.W.T. Operative hip arthroscopy. Ed 2. Thieme, New York2004: 170-189
- Is a hip distractor useful in the arthroscopic treatment of femoroacetabular impingement?.Orthop Traumatol Surg Res. 2011; 97: 381-388
- Evaluation of a sensor for low interface pressure applications.Med Eng Phys. 2000; 22: 657-663
- Hip range of motion and provocative physical examination tests reliability and agreement in asymptomatic volunteers.PM R. 2010; 2: 888-895
- What is the Bonferroni correction?.AAOS Now. 2012; 6
- Trends and demographics in hip arthroscopy in the United States.Arthroscopy. 2013; 29: 661-665
- Beginning hip arthroscopy: Indications, positioning, portals, basic techniques, and complications.Arthroscopy. 2007; 23: 1348-1353
- The supine approach.in: Byrd J.W.T. Operative hip arthroscopy. Ed 2. Thieme, New York2004: 145-169
- Risk of sciatic nerve traction injury during hip arthroscopy—Is it the amount or duration?.J Bone Joint Surg Am. 2012; 94: 2025-2032
- Hip arthroscopic surgery: Patient evaluation, current indications, and outcomes.Am J Sports Med. 2013; 41: 1174-1189
- Pudendal nerve palsy complicating intramedullary nailing of the femur.J Bone Joint Surg Am. 1992; 74: 1450-1455
- Effects of traction, distension, and joint position on distraction of the hip joint: An experimental study in cadavers.Arthroscopy. 2002; 18: 865-871
- Pathophysiology of nerve compression syndromes: Response of peripheral nerves to loading.J Bone Joint Surg Am. 1999; 81: 1600-1610
- Pudendal nerve stretch during vaginal birth: A 3D computer simulation.Am J Obstet Gynecol. 2005; 192: 1669-1676
- Changes in fast axonal transport during experimental nerve compression at low pressures.Exp Neurol. 1984; 84: 29-36
Yamasaki S, Hashimoto Y, Terai S, Takigami J, Takahashi S, Nakamura H. Proposed referential index to resect femoroacetabular cam-type impingement during arthroscopy using a cadaveric hip model. Arthroscopy in press, available online 19 February, 2015. doi:10.1016/j.arthro.2014.12.024.
Article info
Publication history
Published online: May 29, 2015
Accepted:
March 23,
2015
Received:
August 1,
2014
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
