Current Trends in the Use of Postless Hip Arthroscopy: An Updated Survey of the ISHA Membership

Background: Traditionally, hip arthroscopy has been performed with a perineal post, although risks associated with the use of a post include pudendal nerve injury, sexual dysfunction, and other soft tissue complications. Recently, some hip preservation specialists have switched to postless hip arthroscopy techniques to minimize these complications. Purpose: To reevaluate the current international trends in postless hip arthroscopy among hip preservation specialists and to compare these results to the same survey conducted in 2022. Study Design: Cross-sectional study. Methods: An anonymous 11-item survey was sent by email to members of ISHA—The Hip Preservation Society in November 2024. A reminder email was sent approximately 2 and 4 weeks later to facilitate a greater number of responses. The survey investigated ISHA members’ current use of perineal post-assisted or postless hip arthroscopy and any changes in their setup technique during their time in practice. Descriptive statistics were used to report the results of each question in the survey. Comparisons between 2022 and 2024 responses to various questions were made using a chi-square test. Results: A total of 132 surveys were completed from 845 (15.6%) ISHA members; 47% of surgeons currently use a perineal post, 44% use a postless technique, and 9% use either technique depending on the facility at which they are operating. Overall, 74% of perineal post users self-reported rates of postoperative groin-related complications of <1% compared with 97% of postless users ( P = .006). A total of 54 respondents indicated changing their technique from using a perineal post to a postless technique during their time in practice. Of the respondents, 63% reported making the change due to pudendal nerve and/or soft tissue complications and 81% indicated that they have noticed a decrease in the rate of groin-related complications since making the change. In comparing the responses from 2022 to 2024, there were no significant differences found between questions. Conclusion: There has been an increase in the proportion of hip preservation specialists using a postless hip arthroscopy technique in the last 3 years. A majority of surgeons continue to report that they have made the switch from post-assisted to postless hip arthroscopy due to groin-related complications and have noticed a decrease in their complication rate after transitioning to the postless technique.