Hip arthroscopy and periacetabular osteotomy generally improve sexual function in patients, but have a risk of iatrogenic pudendal nerve injury that can temporarily worsen sexual function: A systematic review

PURPOSE: To summarise how orthopaedic hip sports medicine procedures affect patients' sexual function so that surgeons can better counsel their patients on this topic. METHODS: Three databases (MEDLINE, EMBASE and PubMed) were searched on 27 April 2024 with search terms relating to sexual activity and orthopaedic procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Seventeen studies with a total of 5976 patients (6275 joints) were included in this study. Hip arthroscopies were performed in 5812 patients for a total of 6087 surgeries, and 164 patients received 188 osteotomies. Nine of 17 studies reported iatrogenic nerve injury (103/1854; 5.6%), mainly of the pudendal nerve (64/103, 62.1%). All of male, female, and combined male and female sexual function tended to be compromised prior to hip sports medicine surgery and improved after surgery as per International Index of Erectile Function (IIEF) (p = 0.009) and Female Sexual Function Index (FSFI) (p < 0.001) scores. Improvements after surgery were largely due to decreased hip pain and stiffness during sexual activity. Return to sexual activity was reported to be 29.2 ± 20.1 days after hip arthroscopy. Only three studies discussed preoperative counselling on sexual activity. CONCLUSION: Hip sports medicine surgeries can improve sexual function for patients; however, they have a risk of pudendal nerve damage that can temporarily interfere with sexual function. Surgeons should counsel their patients on the risks and benefits of hip sports orthopaedic surgeries to sexual function. LEVEL OF EVIDENCE: Level IV.