The Perineal Post for Hip Arthroscopy Is Dead—Or at Least It Should Be

Traditionally, distraction of the hip joint during hip arthroscopy has been achieved with the use of a perineal post, which acts as a counterforce. However, our knowledge of the potential complications related to the use of a perineal post continues to grow. Although pudendal neurapraxia is the most common of these potential complications, the perineal post also may cause skin tears of the perineum, erectile dysfunction and, in rare cases, permanent pudendal nerve injury. In response, several techniques for performing postless hip arthroscopy have been developed in recent years. Although some of these techniques are commercially available and some are “do-it-yourself,” preliminary evidence has shown minimal risk of groin-related complications with these postless techniques. In addition to reducing complication rates, our research revealed significantly better patient-reported outcomes with postless compared with post-assisted hip arthroscopy at a minimum 1-year follow-up. Groin-related complications during hip arthroscopy are confusing and anxiety-producing to patients. Hip arthroscopy is an elective procedure, and patients do not expect to have any groin symptoms after a hip surgery. Because this is a sensitive issue, the potential for groin-related complications is rarely discussed with patients preoperatively. In addition, patients often are confused and reluctant to mention groin-related complications to their surgeon, especially if these symptoms are short-lived. Postless hip arthroscopy is a readily accessible, safe alternative to using a perineal post and should be adopted as the standard of care sooner rather than later.