Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Rehne Lessmann Hansen,Anna Bertoli Borgognoni,Klaus Kjær Petersen,Mats Bue

doi:10.5194/jbji-7-35-2022

Rehne Lessmann Hansen, Anna Bertoli Borgognoni + Show 2 more

Open Access

https://doi.org/10.5194/jbji-7-35-2022

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Abstract

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

Highlights

Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment
Abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with magnetic resonance imaging (MRI)
We report our experiences after surgically treating SAS in a series of 26 consecutive patients during a 12-year period

Summary

Introduction

Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate. Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions, representing less than one percent of all cases of osteomyelitis cases (el Mezouar et al, 2014), and affect different groups of patients by several distinct aetiologies (Dudareva et al, 2017). Some mistake the symptoms as osteitis pubis, a noninfectious inflammatory condition affecting the pubic symphysis, previously described in patients undergoing urologic procedures, following trauma, in pregnancies and in athletes with groin pain (Gomella and Mufarrij, 2017).

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