Sexual and urinary function post-surgical treatment of femoroacetabular impingement: experience from the FIRST trial and embedded cohort study

Abstract

The goal of this study was to investigate the sexual and urinary function and any related complications in patients post-hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Data from 214 patients enrolled in the FIRST trial and 110 patients enrolled in the trial’s embedded prospective cohort study (EPIC) were analyzed. EPIC patients either refused to participate in the trial or did not meet the FIRST eligibility criteria. Outcomes included the International Consultation on Continence Questionnaire (ICIQ) for males (ICIQ-MLUTS) and females (ICIQ-FLUTS) and the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF) administered before surgery and at 6 weeks and 12 months. Urinary and sexual function adverse events were recorded up to 24 months. Linear regression analyses were conducted to compare the osteochondroplasty and lavage groups in the FIRST trial and to evaluate age and traction time as prognostic factors among all patients. Longer traction time was associated with a small but statistically significant improvement in urinary voiding function in males at 6 weeks and 12 months (MD (95% CI) = 0.25 (0.12, 0.39), P < 0.001 and 0.21 (0.07, 0.35), P = 0.004), respectively. Mean traction time was 43.7 (± 23.2) min for FIRST trial and 52.8 (± 15.2) min for EPIC cohort patients. Increasing age in male patients was associated with a decrease in urinary continence at 6 weeks (MD (95% CI) = 0.25 (−0.42, −0.09), P = 0.003). FIRST male patients who received osteochondroplasty improved significantly in sexual function at 12 months compared to males in the EPIC cohort (MD (95% CI) = 2.02 (0.31, 3.72), P = 0.020). There was an overall complication rate of 1.2% at 24 months [one urinary infection, two instances of erectile dysfunction (one transient and one ongoing at 24 months) and one reported transient numbness of tip of the penis]. Hip arthroscopy for the treatment of FAI has a low rate of sexual and urinary dysfunction and adverse events.

Association of Postless Distraction in Hip Arthroscopy With Decreased Postoperative Groin Numbness

“…Many concerns have been raised regarding the pressure placed on the perineal skin and pudendal nerve compression by the perineal post during hip arthroscopy. 3,8,11,13,15,24,26 Martin et al 17 demonstrated several detrimental physiologic changes that occur intraoperatively on a traction table with a perineal post, including decreased popliteal vein blood flow, nerve conduction velocity changes, and increased muscle tissue damage (measured by D-dimer and creatine-phosphokinase). These physiologic changes that occur with perineal post distraction seem to be mitigated by adoption of a postless distraction method, as demonstrated by Welton et al, 30 with no notable reduction in popliteal venous blood flow, no changes in nerve function, and only minimal transient muscle tissue damage when compared with perineal post distraction.…”

“…5 Despite the reported favorable complication profile, 16 many recent studies have reported complications related to the use of a perineal post, including pudendal neuralgia, perineal skin and genitalia injury, sexual dysfunction, and urinary dysfunction. 11,13,24,26,31 More recently, newer methods of postless hip distraction have emerged to mitigate these post-related complications. 12,14,18,27 Early studies have supported the multiple benefits of postless distraction over traditional post distraction methods, including a lower amount of traction force required to provide adequate hip distraction 21,22 and fewer intraoperative changes in venous blood flow, nerve conduction, and muscle tissue damage.…”

Editorial

“…My second pick is from Olufemi Ayeni’s team, at McMaster, who provide a paper on sexual and urinary function post-surgical treatment of femoroacetabular impingement [ 18 ]. It is a gem of scientific investigation into an area that we all want to know about and be able to advise our patients.…”