Postless vs. traditional hip arthroscopy: A multilevel meta-analysis of current evidence on efficacy and safety.

Purpose: To date, no meta-analysis has systematically compared postless and post-assisted hip arthroscopy (HAS). This underscores the need for a structured synthesis of current evidence. To address this gap, a multilevel meta-analysis was conducted to systematically compare outcomes and complication rates of HAS performed with and without a perineal post.

Methods: A comprehensive search of PubMed, Embase, Epistemonikos, and CENTRAL was completed on 20 July 2025. A frequentist multilevel meta-analysis with random-effects modelling and Hartung-Knapp adjustment was conducted. Outcomes were summarised as pooled mean differences and proportions with 95% confidence intervals.

Results: Eight primary studies including 1880 hips were analysed. The pooled nerve injury rate was higher in the traditional HAS group (7%; 95% confidence interval [CI]: 0.01-0.36) compared to the postless group (3%; 95% CI: 0.00-0.20), with a significant subgroup difference (F  =  10.81; p < 0.01). Mean traction time was longer in the traditional group (58.5 min) than in the postless group (52.2 min), also with a significant difference (F =  32.96; df = 1.50; p < 0.01). Other subgroup comparisons showed no significant differences.

Conclusion: While trends suggest potential advantages of postless hip arthroscopy in certain outcomes, the evidence remains limited by study heterogeneity and design. These results support its growing clinical use, though further prospective comparative studies are needed to strengthen the evidence base.

Level of evidence: Level II, systematic review and meta-analysis.