Osteitis Pubis Research Articles

Osteitis Pubis and Adductor Strain in an Athlete Initially Treated for Femoroacetabular Impingement (FAI)

Osteitis Pubis and Adductor Strain in an Athlete Initially Treated for Femoroacetabular Impingement (FAI)

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

ObjectiveTo determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.DesignSystematic review.Data sourcesWe followed the Preferred Reporting Items...

Efficacy of modified active physical therapy program on pain, muscle strength, and function in adolescent football players with osteitis pubis

BackgroundIn athletes, osteitis pubis (OP) is considered a major cause of chronic groin pain. In addition to the difficulties with diagnosis, controversy exists regarding the most appropriate treatment approach. The study aimed to evaluate the effect of a modified active physical therapy program (MAPT) on pain, hip and trunk muscle strengths, and lower extremity function in adolescent football players with OP.MethodsFifty football players aged from 12 to 18 years with OP were included and allocated into two groups: the MAPT group (n = 24) and the traditional physical therapy (TPT) group (n = 26). Each group received a different treatment protocol for 60 min applied 3 times/week for 12 weeks. A visual analog scale, digital hand-held dynamometer (HHD), and lower extremity functional scale (LEFS) were used to measure pain, hip and trunk muscle strengths, and lower limb function, respectively, at baseline and 12 weeks post-intervention.ResultsThere was a highly significant difference in the TPT group’s pain score (p < 0.001) compared with the MAPT group. Also, the strength of hip flexors, abductors, adductors, internal rotators, external rotators, and trunk flexors and extensors improved significantly (p < 0.05) than the TPT group. However, the between-group analysis revealed that the strength of hip extensors and LEFS in the MAPT group achieved a highly significant difference (p < 0.001) compared with the TPT group.ConclusionMAPT could be recommended strongly in the rehabilitation of OP in adolescent football players in which the functional abilities of OP patients improved because of reduced pain levels and increased hip and trunk muscle strength. (IRCT20210909052421N3, Iranian Registry of Clinical Trials, https://www.irct.ir/trial/68946/pdf, 9-April-2023).

Midterm Functional Outcomes of Arthroscopically Treated Recalcitrant Osteitis Pubis in Competitive Soccer Players.

Outcomes after arthroscopic debridement for isolated osteitis pubis in athletes are unknown, and midterm results following this method have not been established. To evaluate the safety and efficiency of arthroscopic treatment for recalcitrant osteitis pubis in competitive soccer players. It was hypothesized that this treatment modality would yield clinical improvement in functional and patient satisfaction scores compared with preoperative values. Case series; Level of evidence 4. At a single center, 10 consecutive male soccer players (mean age, 23.6 ± 4.4 years; range, 19-32 years) with a mean follow-up period of 72.2 ± 13.4 months (range, 60-97 months) were evaluated. All patients presented with symptomatic osteitis pubis and failed to respond to nonoperative treatment. Arthroscopic pubic symphysiectomy was performed in the supine position, and penile manipulation was performed in all cases to mitigate risks associated with neurovascular structures and the root of the penis. Outcome measurements were time to return to sports, visual analog scale (VAS) for pain, Nirschl Phase Rating Scale (NPRS), Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and patient satisfaction. Preoperative and postoperative radiographs were also assessed. The mean time to return to sports was 4.6 ± 1.7 months (range, 3-8 months). The mean VAS pain score decreased from 9.3 ± 0.8 (range, 8-10) to 0.2 ± 0.4 (range, 0-1) (P = .005). The mean NPRS decreased from 6.6 ± 0.5 (range, 6-7) to 0.3 ± 0.5 (range, 0-1) (P = .004). The mean NAHS increased from 35.8 ± 16.7 (range, 14-72) to 98.2 ± 2.7 (range, 93-100) (P = .005). The mean mHHS increased from 47.4 ± 10.6 (range, 27-60) to 98.2 ± 4.5 (range, 86-100) (p = .005). The mean patient satisfaction was 9.7 ± 0.7 (range, 8-10). Scrotal swelling was observed in 4 patients, which was resolved 36 to 48 hours postoperatively. Arthroscopic treatment of osteitis pubis may be an option for recalcitrant cases when nonoperative treatment fails. However, further studies are needed to determine whether this technique and the outcomes of this study can be reproduced.

Pubic osteitis following pubic adenomectomy: Case report

Osteitis pubis is a condition that mainly affects young people. It rarely occurs after urological surgery. It is a diagnostic and therapeutic emergency. Diagnosis is based on clinical findings, which vary widely from simple pelvic tenderness to pain that limits walking. Imaging and additional bone biopsy must be performed to confirm the diagnosis. Treatment is based on long-term antibiotic therapy, appropriate analgesics and muscle re-education with radiological drainage if necessary. In this article, we report a case of osteitis pubis after suprapubic adenomectomy.

Targeted Injection can Improve Groin Pain Management in Osteitis Pubis: A Narrative Review

Targeted Injection can Improve Groin Pain Management in Osteitis Pubis: A Narrative Review

Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability

ObjectiveTo compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability.MethodsSixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded.ResultsSymphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23.ConclusionDedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability.Clinical relevance statementFor diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients.Key Points• Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography.• Additional fluoroscopy may be important for therapeutic injections.• The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.

Groin pain in athletes-sportsmen's groin

Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near the pubic bone can be clearly identified. Magnetic resonance imaging (MRI) is the imaging modality of choice, as well as single-leg stand imaging (flamingo view radiographs), and where appropriate symphysography. Optimized MRI sequence protocol with oblique (axial oblique) slices parallel to the linea arcuata of the iliac bone is recommended. High-resolution MRI sequences and symphysography can detect superior and secondary cleft formation. Instabilities of the pubic symphysis can be diagnosed using flamingo view radiographs. The MRI findings of osteitis pubis and clinical symptoms correlate. The presence of parasymphyseal bone marrow edema is the earliest morphological sign of acute osteitis pubis on MR imaging. Edema in the periosteal tissue and isolated muscle lesions next to the symphysis are generally associated with more severe clinical symptoms. Close communication between radiologists and the referring physicians is indispensable when planning an adequate imaging protocol, and precise knowledge of the clinical symptoms in the case of clinical suspicion of osteitis pubis allows for areliable diagnosis and provides important prognostic information.

Primary care level prevalence of osteitis pubis in non-athlete patients in hill region: A short communication and a proposal for simple radiological grading.

Osteitis pubis (OP) is inflammation of pubic symphysis associated with varying degrees of supra-pubic, pelvic, or lower abdominal pain. The condition may be severe in many patients with significant disability and protracted course of recovery. The condition is frequently described in sportspersons or athletes but consensus on classification and treatment guidelines is non-existent due to rarity of the condition. Its presence in non-athletic population is limited to a series of few cases or anecdotal case reports. Our study describes salient features of pattern of this disorder diagnosed on clinico-radiological basis in cases referred from primary care centers to our tertiary care center. A total of 26 patients (mean age of 36.28 years, 25 females, and 1 male case) with radiological features suggestive of OP were included in the study and relevant demographic details were noted for each. A radiological grading (Grade A to E) for notification was developed and the cases were categorized accordingly. Most of the cases were hard-working women from villages. Pregnancy was the major condition for which they ever consulted a health-care facility. Chronic, but not disabling, supra-pubic pain was the chief complaint in most cases. In some cases, the primary presentation was for some other disorder like low back pain in two, hip pain in six cases, adjacent fracture in three, and old lumbar osteoporotic compression fracture in one case. Other notable associated disorders included polio, ankylosing spondylitis, femoroacetabular impingement, and hip dysplasia. Conservative management was done in all cases except one with associated fracture. Good clinical outcome was noted in all but one case. Grade A cases were maximum (7) followed by grade B (6), grade D (4), and grade C (3). Only one case of grade E was noted with almost ankylosed symphysis. This article highlights acknowledgment and knowledge of OP in primary care settings and its anticipation even in normal population for a better understanding of prevalence and radiological presentation.

LBODP065 Rare Cause Of Bone Pain In MEN Syndrome

Abstract Introduction: MEN 1 syndrome is a rare disease in children and young adults, with prevalence reported as 2 per 100,000. MEN 1 caused by mutations in the MEN1 tumor suppressor gene, characterized by 2 or more MEN1 tumors: parathyroid, anterior pituitary, pancreatic islet tumors. To the best of our knowledge, osteomyelitis of the pelvis has not been reported as a complication in the literature in patients who were diagnosed with MEN1Case21 yo male from Honduras with PMHx of remote asthma presented with a common complaint of abdomen pain but found to have a rare diagnosis. He had 2 days of lower abdomen pain associated with non-bilious non bloody vomiting. Initial were significant for calcium 12.9, phosphorus 1.5 magnesium 1.8 and PTH 360. 4 mm renal stone 4 mm was detected on CT abdomen/pelvis. The initial EKG demonstrated J point elevation due to the hypercalcemia. He was admitted to the PICU for continuous telemetry monitoring due to the abnormal EKG related to electrolyte abnormalities. Hypercalcemia treatment was initiated with aggressive hydration, calcitonin administration as well as zoledronic acid administration. The patient's calcium levels improved as well as EKG. The parathyroid scan was positive for a right-sided parathyroid adenoma. He underwent right Inferior Parathyroidectomy, Intraoperative Nerve Monitoring, Cryopreservation of Parathyroid Tissue. As part of his diagnostic work-up for hyperparathyroidism, he was screened for MEN. His pituitary function was abnormal: ACTH and cortisol levels were high, his testosterone and gonadotropins were inappropriately low as well as TSH and T4. A microadenoma was present on brain MRI. No Pancreatic Neuroendocrine Neoplasia was found. The diagnosis of MEN 1 was made. Despite the improvements in his endocrinopathies, he continued to have lower abdomen pain associated with intermittent fevers. He was seen by urology and orthopedics. Initially MRI demonstrated bone erosion thought to be secondary to hypercalcemia but repeat MRI imaging of the pelvis was suspicious for phlegmon vs. developing abscess secondary to osteitis pubis. His blood cultures were positive for MSSA. He was started on antibiotics with continued clinical improvementThis patient presented with one of the most common complaints in the ED, abdomen pain and was found to have two rare and potentially fatal diagnosis which was identified and treated with a good clinical outcome Discussion: This case highlights a rare disease in the setting of osteomyelitis which could easily be missed as a manifestation of bone pain from hypercalcemia. The patient did experience fevers and malaise that was initially attributed to zoledronic acid administration. When his pain did not resolve MRI found osteomyelitis, allowing early antibiotic administration and prevention of sepsis. Presentation: No date and time listed

Hip Range of Motion and Strength in Male Athletes with Stage 1 Osteitis Pubis: A Cross-Sectional and Correlational Study.

Background: The objectives of this study were: (1) to determine whether athletes with stage 1 osteitis pubis (OP) present differences in hip range of motion (ROM) and muscle strength, between both sides and compared with healthy athletes; (2) to investigate the relationship between the internal rotation (IR) ROM and pain intensity and physical function. Methods: a cross-sectional and correlational study was designed, in which 30 athletes (15 athletes with stage 1 OP and 15 healthy athletes) were included. Pain intensity, physical function, hip ROM and hip muscle strength were assessed. Results: The ROM assessment reported significant differences between both groups in the IR, external rotation (ER) and adduction (ADD) ROM of the painful side (PS) (p < 0.05). The OP group showed differences between both sides in IR ER and ADD ROM (p < 0.05). No statistically significant differences were found between or within groups in the maximum isometric strength of the hip (p > 0.05). A strong negative correlation between pain intensity and IR ROM (r = −0.640) and a strong positive correlation between physical function and IR ROM (r = 0.563) were found in the OP group. Conclusions: Male athletes with stage 1 OP present a hip IR, ER and ADD ROM limitation in the PS compared to non-PS and to healthy athletes. IR ROM is correlated to pain intensity and physical function in athletes with stage 1 OP.

Osteomyelitis Pubis After Initiation of an SGLT2 Inhibitor

Osteomyelitis pubis is a rare infectious entity that is often misdiagnosed. Early clinical suspicion and appropriate diagnostic workup are required to prevent a delay in diagnosis and to differentiate the disease from alternative noninfectious diagnoses such as osteitis pubis. Herein, we report a case of osteomyelitis pubis with delayed diagnosis in a patient who recently initiated an SGLT2 inhibitor before the onset of symptoms. The effect of SGLT2 inhibitors on the risk of this disease is unknown but may warrant further investigation, as this case highlights.

Comparison of hip abductor and adductor muscle performance between healthy and osteitis pubis professional footballers.

The study aimed to compare the concentric and eccentric muscle performance of the hip abductor and adductor muscles at a high angular velocity in football players with osteitis pubis and healthy players. A total number of 32 male football players with osteitis pubis and 20 healthy footballers were tested using an isokinetic dynamometer at a speed of 180°/s. Hip abductor and adductor peak torque/body weight, time to peak torque, acceleration, and deceleration times produced during concentric and eccentric muscle contraction modes were measured using a Biodex dynamometer. Football players with osteitis pubis demonstrated a significantly higher time to peak torque, acceleration, and deceleration times (p < 0.05); however, when compared to healthy athletes, there was no significant change in muscle strength. The present study showed that football players with osteitis pubis had a reduction in neuromuscular reaction. Therefore, the reaction time of these muscles is critical, and the reduction could result in magnified stresses and/or poorly distributed loads across the musculotendinous structure of the anterior pelvis, which presumably could lead to the development of osteitis pubis. Incorporate findings of the current study in clinical practice could afford critical information when evaluating the hip muscles in football players with osteitis pubis, for pre-screening, enhancing the rehabilitation programs, and guiding the decision of returning to sports after injury.

The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence.

ObjectiveThe objective of this study is to summarise the contemporary evidence regarding the prevalence, diagnosis, and management of osteitis pubis (OP) specially from urological point of view, while proposing an algorithm for the best management based on the current evidence.MethodsWe performed a literature search using the PubMed database for the term ‘osteitis pubis’ until December 2020. We assessed pre‐clinical and clinical studies regarding the aetiology, pathophysiology, and management of OP. Case reports and case series were evaluated by study quality and patient outcomes to determine a potential clinical management algorithm.ResultsOsteitis pubis is a chronic painful condition of the symphysis pubis joint and its surrounding structures. Still, there is a paucity of data outlining the management plan and the possible triggers. The aetiology seems to be multifactorial with different proposals trying to explain the pathophysiology and correlate the findings to the outcome. The diagnosis is usually based on high suspicion index and clinical experience. The infective variant of the disease is aggressive and requires strict and active management. Universal consensus is still lacking regarding a formal algorithm of management of the condition, especially due to multiple specialities involved in the decision‐making process. Conservative management remains the cornerstone; nevertheless, surgical interventions may be needed in special settings. Hence, a multi‐disciplinary approach is of pivotal value in fashioning the plan for each case. The prognosis is usually satisfactory; however, a longstanding debilitating disease form is not uncommon.ConclusionOP remains a rare condition with real challenges in its diagnosis. The current management is focused on conservative management; however, surgical intervention is still needed in some difficult scenarios. Continued research into the triggers of OP, multidisciplinary approach, and standardised clinical pathways can improve the quality of care for patients suffering from this condition.

Osteitis Pubis in Athletes: A Literature Review of Current Surgical Treatment.

Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes.A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications.Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically.The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.

Deficits in eccentric antagonist/concentric agonist strength ratios: a comparative study of football players with and without osteitis pubis.

Dynamic hip stabilizers are essential for optimal performance in football players, particularly during kicking. Although the muscle strength deficits of hip muscles as an etiology of osteitis pubis (OP) in football players have not yet been well investigated, previous assessments give more attention to the concentric mode of strength for both hip flexor and extensor muscles. Functionally, the hip muscles interact in an eccentric/concentric pattern. This study aimed to compare the concentric, eccentric, and eccentric antagonist/concentric agonist ratios for hip flexor and extensor strength between football players with OP and healthy athletes. Thirty-four male footballers with OP and eighteen healthy footballers were tested using an isokinetic dynamometer at a speed of 180°/s. Football players with osteitis pubis demonstrated a significantly lower eccentric extensor/concentric flexor ratio and higher eccentric hip flexor/extensor ratio (p < 0.05) when compared with healthy participants. The present study demonstrated that football players with OP had a reduced capability to produce eccentric hip extension torque compared to healthy athletes. Consequently, the eccentric rather than the concentric weakness of hip extensors could be suggested as one of the intrinsic contributing factors for OP. Incorporating findings of the current study in clinical practice could afford critical information while evaluating the hip muscles in football players with OP for pre-screening, developing rehabilitation programs, and guiding the decision to return to sports after injury.

PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS.

ABSTRACTIntroduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

Arthroscopically assisted minimally invasive symphysioplasty for the treatment of pubic related groin pain

Therapy of pubic related groin pain via minimally invasive symphysioplasty. Therapy of refractory pubic related groin pain based on osteitis pubis. Groin pain from causes other than pubic related groin pain. After aminimally invasive approach, an incision in the anterior capsule is made while protecting the dorsal capsule parts and the arcuate pubic ligament. The symphysis end plates are remodeled arthroscopically assisted using asurgical burr. The newly created pubic symphysis joint is filled with autogenous fibrin to support the formation of anew discus interpubicus. Partial weight-bearing for 4weeks with 20 kg using crutches is recommended. During the first 4weeks the range of motion should be restricted. Since2010, 10athletes (7men, 3women; average age 34.1 ± 7.8 (23-47) years) have undergone arthroscopically assisted minimally invasive symphysioplasty and treatment of femoroacetabular impingement syndrome. The average follow-up time was 5.1 (2-9) years. All patients returned to their sport level. The mean preoperative Nonarthritic Hip Score (NAHS) of 64.4 ± 15.1 (32.1-86.5) points improved to amean postoperative NAHS of 91.4 ± 9.8 (62.4-98.75) points (p < 0.0001). The average patient satisfaction (scale0 to10; 10highest satisfaction) was 9.8 ± 0.4 (9-10).

The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia.

ABSTRACTFemoroacetabular impingement syndrome (FAIS) has been associated with osteitis pubis; however, it is still unclear whether hip dysplasia is associated with osteitis pubis. This study aimed to investigate (i) the incidence of pubic bone marrow edema (BME) on magnetic resonance imaging in symptomatic patients with FAIS, borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) undergoing hip arthroscopic surgery with labral preservation and (ii) the demographic and radiographic factors associated with pubic BME. A total of 259 symptomatic patients undergoing hip arthroscopic surgery between July 2016 and April 2019 were retrospectively reviewed and divided into three groups: FAIS (180 patients), BDDH (29 patients) and DDH (50 patients). Diffuse changes in the pubic bone adjacent to the pubic symphysis were labeled pubic BME, and the prevalence of their occurrence was examined. Multivariate logistic regression analysis was performed to identify factors involved in pubic BME, and odds ratios (ORs) for relevant factors were calculated. There was no significant difference in the prevalence of pubic BME among the three groups (20 [11.1%] of 180 FAIS patients, 6 [20.6%] of 29 BDDH patients and 7 [14%] of 50 DDH patients, P = 0.325). Multivariate logistic regression analysis showed that acetabular coverage was not associated with pubic BME, whereas younger age and greater alpha angle were still independent associated factors [age ≤26 years (OR, 65.7) and alpha angle ≥73.5° (OR, 4.79)]. Determining the possible association of osteitis pubis with cam impingement in dysplastic hips may provide insights toward a more accurate understanding of its pathophysiology.

Arthrodesis of the Pubic Symphysis With Compression Plating and Femoral Strut Allograft for Pubic Instability and Osteitis Pubis: A Novel Surgical Technique

Introduction: Osteitis pubis and pubic instability represent an uncommon, yet a potentially debilitating problem for patients. While many cases are amendable to conservative measures, the few recalcitrant cases present a difficult challenge for surgical management with the risk of implant failure, nonunion, and potential complications. Materials and Methods: A retrospective review of 3 patients undergoing symphyseal arthrodesis with a strut allograft for osteitis pubis and/or pubic instability after failed conservative management was conducted at a single institution. Preoperative evaluation, surgical technique, and postoperative regimen are thoroughly described. Surgical complications, reoperation rate, pain, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, as well as radiographic outcomes were reported. Results: Three patients undergoing our symphyseal arthrodesis technique after failed conservative management were identified. All patients had an improvement from preoperative pain levels and the 2 patients with &gt;12-month follow-up were able to return to full activity, including 1 patient returning to full active duty in the United States Army. Discussion: The unique technique presented here utilizes both implant fixation, as well as allograft supplementation to improve fusion rates. Although a limited sample with limited follow-up, the early results of this novel technique are encouraging and may represent a more reliable surgical option for patients with chronic, recalcitrant pubic instability.