A Comparison of Postoperative Complications and Clinical Outcomes in Postless Versus Post-Assisted Hip Arthroscopy: A Systematic Review and Meta-analysis of Nonrandomized Comparative Studies

Background: Hip arthroscopy with a perineal post (ie, post assisted) may contribute to postoperative nerve and soft tissue complications. Postless hip arthroscopy has been increasingly used as an alternative to limit these postoperative nerve-related complications. Purpose: To compare the complication rates, such as pudendal nerve injury and perineal numbness, as well as any potentially reported clinical outcomes in patients undergoing postless versus perineal post-assisted hip arthroscopy. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, MEDLINE, and Embase databases were searched until November 2024 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which yielded 2171 studies. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS) criteria, and postoperative complications (ie, visual analog scale VAS, modified Harris Hip Score, the Hip Outcome Score–Sports Specific Subscale), and outcomes were compiled in a meta-analysis where appropriate. Continuous outcomes were obtained using the mean difference (MD) while dichotomous outcomes were reported as odds ratios (ORs) that were calculated using the Cochran-Mantel-Haenzel method. Results: Five studies, from 4 patient cohorts, were included that comprised a total of 707 patients (60% female) with a frequency-weighted mean age of 29.9 years (range, 26.1-34 years). The mean MINORS score was 19.4 ± 1.1 (range, 18-21) with studies ranging from low to moderate quality. The pooled incidence of nerve or soft tissue injury from 2 studies was 48.1% (74/154 patients) for post-assisted and 31.3% (40/128 patients) for postless groups. Meta-analysis indicated a significantly lower incidence of nerve or soft tissue injury associated with postless hip arthroscopy (OR, 0.50; 95% CI, 0.31 to 0.82; P = .006). The pooled incidence of perineal numbness from 2 studies was 22.7% (35/154 patients) and 0.8% (1/128 patients) in the post-assisted and postless group, respectively. Meta-analysis demonstrated a significantly lower incidence of perineal numbness associated with postless hip arthroscopy (OR, 0.04; 95% CI, 0.01 to 0.21; P = .0002). Postless hip arthroscopy required lower traction time (MD, −6.15 minutes; 95% CI, −8.23 to −4.07 minutes; P = .00001) and holding traction force (MD, −12.12 kg; 95% CI, −15.32 to −8.93 kg; P = .00001) compared with post-assisted hip arthroscopy. Two studies reported VAS, with both studies indicating no significant difference between groups at either the postanesthesia care unit period or at 2 years’ follow-up. Conclusion: Our review showed that postless hip arthroscopy was associated with a significantly lower incidence of nerve or soft tissue injuries and perineal numbness, as well as reduced traction time and force, compared with the conventional post-assisted technique. However, the current paucity of comparative data in assessing complication rates and hip-related patient-reported outcome measures between post-assisted and postless hip arthroscopy techniques warrants further investigation.