Sacroiliac joint (SIJ) fusion is a controversial yet last resort operative technique to address SIJ pain. The current study aims to determine the patient outcomes of SIJ fusions, in a single surgeon series utilising an anterior approach with 2 DC plates across the joint and iliac crest autograft. Retrospective case series involving 11 patients who had 13 SIJ fusions performed over an 8 year period (2002–2010). Patients were identified by electronic key word search from databases at Middlemore hospital and the private sector. Dictated clinic letters and operation notes were reviewed to obtain demographic data and outcomes data including complications. Postoperative radiology reports were reviewed to document radiographic fusion status. Telephone interviews were conducted to measure clinical outcome scores via the Majeed Pelvic Score and the 12-item Short-Form Health Survey (SF-12). 10 out of 11 patients (entailing 12 SIJ fusions) responded and participated in the study, equating to over 90% follow up. 2 cases were managed at Middlemore Hospital, with the remainder in the private sector. All cases but one had a ‘post-traumatic arthritis’ etiology. Diagnosis was made by CT guided local/steroid injection into the joint in conjunction with CT/bone scan/MRI imaging. The Majeed score improved markedly for 9 of 12 SIJ fusions (75%). 10 of 12 patients stated they would have the procedure again. 7 of 12 fusions (58%) had postoperative complications including blood loss, haematoma, nerve injury (including one case of permanent foot drop), non-union, infection of the joint/metal ware, hernia and urinary retention. 5 of 12 fusions (42%) experienced altered sensation over the lateral femoral cutaneous nerve distribution. All except one patient eventually had x-rays or CT scans postoperatively that reported radiographic fusion of the joint. In appropriately selected patients with SI joint arthrosis, 3/4 patients reported significant improvement in function and pain level after SIJ fusion. Chronic pain (from other sources) and major complications were a feature amongst those failing to benefit. Lateral femoral cutaneous nerve palsy has high incidence with the current operative technique

Purpose of the study: Primary bone tumors of the sacroiliac joint are difficult to diagnose. We present the procedure used to resect these tumors and reconstruct the pelvic ring, and the carcinological and functional outcome. Materials and Methods: This was a retrospective analysis of a consecutive series of patients treated for a tumor of the iliac bone or of the sacrum which involved the sacroiliac joint. Tumor grading was based on the Enneking classification and the functional outcome on the MSTS score. Results: From 1986 to 2003, 24 patients were treated for a a tumor involving the sacroiliac joint. Six with invasion of the sacral body. The histology was osteosarcoma (n=8), chondrosarcoma (n=8), malignant hystiocytofibroma (n=3), Ewing’s sarcoma (n=2), schwannoma (n=1), leiomysarcoma (n=1) and haemangiopericytoma (n=1). Seventeen patients were given neoadjuvant chemotherapy. A wide crest approach was used to access both aspects of the pelvic ring. Neurological sacrifice was required in six patients. Operative time was 5.27 hours on average. Reconstruction was achieved with an autograft and instrumentation. The resection was wide in 11 cases, marginal in 12, and contaminated in one. The mean follow-up was 4.77 years. Ten patients died from their disease. Survival was correlated with the quality of the resection and with the initial tumor stage. Hemisacrectomy did not affect survival. Bone healing was achieved in 13 patient, ten who survived. The mean MSTS score was 48% at last follow-up in 14 survivors. For the nine patients who did not require neurological sacrifice, the mean score was 58%. For the five other patients, the mean score was 38% This score was 65% in patients with bone healing and 8% in those with nonunion. Discussion: The survival of patients with a tumor of the sacroiliac joint is basically related to the histological diagnosis and the quality of the resection. If the disease can be controlled, the method of the reconstruction proposed here enables bone healing with a satisfactory functional result when neurological sacrifice can be avoided

Generally, the sacroiliac joint is not considered accessible for arthroscopy under physiological conditions. The non-injured joint is not large enough for introduction of even the smallest arthroscope into the joint space. After traumatic injury however, or in the event of an inflammatory condition or tumour formation, it is theoretically possible to position an endoscope in the joint space. Study of the anatomy of the sacroiliac joint and knowledge of the anatomic relations, particularly the vascular and nervous relations, is a prerequisite for arthroscopic exploration of the sacroiliac joint space. The posterior approach must account for the bone configuration of the iliac wing and the orientation of the sacroiliac joint line. A cadaver study confirmed the feasibility of endoscopic exploration of the sacroiliac joint via a posterior percutaneous access. Based on this anatomic experience, we positioned an arthroscope in an injured sacroiliac joint and report the different phases. A technique for obtaining a biopsy of the anterior aspect under endoscopic control has already been described, but to our knowledge, there is no arthroscopic description of the sacroiliac joint via a posterior access. Indications for arthroscopy of the sacroiliac joint remain very limited. This technique can be used to remove osteocartilaginous fragments or foreign bodies incarcerated in the joint and to obtain biopsy material, drain collections and, in the near future, should allow avivement of the cartilage surfaces with the objective of a percutaneous arthrodesis

Introduction Sacroiliac joint pain is resistant to diagnosis by clinical methods. CT guided diagnostic blocks are the gold standard in diagnosing SI joint pathology (Maigne J.Y. et al, Spine 1996). The current blocks have various pit falls. We have devised a new functional diagnostic block which is a modification of the currently available blocks for diagnosing sacroiliac joint pain. Methods The patient suspected of having sacroiliac joint pain undergoes a CT-guided sacroiliac joint catheterisation. The patient is subsequently admitted to the hospital for two full days. On admission patient is charted for an injection of either a local anaesthetic or normal saline (placebo) through the catheter into the joint 2–3mls every 3–4 hourly. Only one drug is administered on any given day. On day one, the nurse in charge of the patient by the flip of a coin will decide to give one of the drugs for the day, the patient or the treating doctor not aware of the drug injected. The first injection starts at 0600hrs and the last injection at 2200 hrs. The injection details and pain score are documented on a standardised form. The patient is then taken through a range of physical activity which usually provokes the sacroiliac joint pain. The next day, the patient receives the alternate drug and undergoes the same protocol. On the third morning the patient is discharged with an appropriate follow-up. The injection given, average pain score and the level of comfort with physical activity are summarised into a form. Discussion Our modified block has the following advantages, it is a double blinded assessment, the effect of a placebo can be tested, and it is also a functional assessment which is recorded over two days and not just a one-off response. The conclusion of the block is determined by the patient’s response and not examiner depended

Introduction. Percutaneous radiofrequency lesioning of the lateral branches of the sacroiliac joint has become a recognised method of treating chronic pain arising from this joint. Due to the large and varied innervation from the S1-3 lateral branches success has been achieved with large lesions that has a high chance of covering these nerves. Such lesions require specialised and expensive equipment and the NIMBUS needle is a large 17G electrode with expandable tines at the tip. It is compatible with all standard radiofrequency probes and it produces a large lesion at the tip. It has been in use in the USA in over 100 cases and we describe its use in the UK. Methods. Patients were identified as having sacroiliac joint pain by clinical assessment and positive pain response to local anaesthetic sacroiliac joint lateral branch blocks. Under fluoroscopic control, the needle is inserted at the lateral edge of the sacral S1-3 posterior foramen. Three lesions at the lateral edge of the foramen are made at 80°C for 90s. A further lesion is made at the L5 dorsal ramus. Results. 4 patients achieved very good pain relief >50% reduction in pain scores on the NRS scale at 6 weeks follow up. No complications were noted and there were no technical difficulties. Conclusion. Lesioning with the NIMBUS needle is feasible and allows clinicians a method of treating chronic sacroiliac joint pain using existing radiofrequency equipment. Further large, long term studies are warranted to establish clinical efficacy

Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac joint (SIJ) fusion using HA-coated screw (HACS) vs triangular titanium dowel (TTD). First study of its kind in English literature. Methods. 40 patients underwent percutaneous SIJ stabilisation using HACS and TTD was used in 70 patients. Patients were followed up closely and outcome scores were collected prospectively. PROMs were collected preoperatively and 12 months after surgery. Short Form (SF)-36, Oswestry Disability Index, EuroQol-5D-5L and Majeed Pelvic Scores were collected. Shapiro-wilk test was used to determine normality of data. Mann-whitney U test was used to compared non-parametric data and Independent sample T test for parametric data. Results. 33 patients in HACS group and 61 in TTD group completed follow-up. There was no significant difference in all preoperative PROMs in both groups hence the data was considered comparable. All postoperative PROMs were significantly higher in the TTD group. In the HACS group, 21 patients (63%) had lysis around the screw and a sub-group analysis showed that improvement in PROMs was significantly less in patients with lysis around the screw. 4 patients with lysis around the screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. In TTD group only 5 patients (8.2 %) patients had radiological evidence of lysis. Relative risk of developing lysis was 6.7 times higher in HACS group. Conclusion. Percutaneous SIJ fixation procedure has been shown to have good clinical outcomes and TTD leads to significantly better patient reported outcomes compared to HACS. There is a 6.7 time higher risk of lysis with use of HACS and lysis is a risk factor for poor outcomes

Abstract. Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac joint (SIJ) fusion using HA-coated screw (HACS) vs triangular titanium dowel (TTD). First study of its kind in English literature. Methods. 40 patients underwent SIJ stabilisation using HACS and TTD was used in 70 patients at CAVUHB, Cardiff. PROMs were collected prospectively before surgery and 12 months post-op. Short Form (SF)-36, Oswestry Disability Index, EuroQol-5D-5L and Majeed Pelvic Scores were collected. Shapiro-wilk test was used to determine normality of data. Mann-whitney U test was used to compared non-parametric data and Independent sample T test for parametric data. Results. 33 patients in HACS group and 61 in TTD group completed follow-up. There was no significant difference in all preoperative PROMs in both groups hence the data was considered comparable. All postoperative PROMs were significantly higher in TTD group. In HACS group, 21 patients (63%) had lysis around screw and sub-group analysis showed that PROMs were lower in patients with lysi. 4 patients with lysis around screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. In TTD group only 5 patients (8.2 %) patients had radiological evidence of lysis. Relative risk of developing lysis was 6.7 times higher in HACS group. Conclusion. Percutaneous SIJ fixation procedure has good clinical outcomes and TTD leads to significantly better patient reported outcomes compared to HACS. There is a 6.7 time higher risk of lysis with use of HACS and lysis is a risk factor for poor outcomes

Crescent fractures are represented by a spectrum of morphological fracture patterns, sharing a common mechanism of injury. We propose three distinct types according to the extent of Sacroiliac (SI) joint involvement and the size of the crescent fragment, which enables a pragmatic choice of surgical approach and stabilisation technique. Crescent fractures are fracture dislocations of the SI joint in which there is variable amount of disruption of the SI ligaments extending proximally as a fracture of the posterior iliac wing. We identified three groups of Crescent fractures according to the extent of SI joint involvement, relationship of the fracture line to the S1 and S2 nerve root foramina on anteroposterior and outlet plain radiograph views, and CT films. Type I involves the less than inferior third of the SI joint with a large posterior iliac fragment left attached to the sacrum. This is best approached anteriorly for stabilisation. Type II has between one-third to two-thirds involvement of the SI joint and is treated according to Helfet's technique. Type III has a very small crescent fragment left attached to the sacrum and the inferior two-thirds of the SI joint is disrupted. This is treated with percutaneous SI screws, but will need anterior open reduction in delayed presentations. Based on this, we treated sixteen patients and followed them for at least two years. There were four Type I, four Type II and eight Type III fractures. Fifteen had anatomical reduction and stabilisation of the SI joint with good functional results. Delayed referral, the presence of significant soft tissue injury posteriorly and infected external fixator pins. From our experience we would like to propose this functional classification of crescent fractures which we find useful in making a choice of surgical approach and stabilisation technique to achieve satisfactory reduction and stabilisation of sacroiliac joint

Objectives. The additive use of an external modular device may improve dorsal compression forces in pelvic external fixation. This would improve the efficiency of indirect reduction and stabilization with an anterior pelvic external fixator. The purpose of this study was to determine the forces of the posterior pelvis achieved by a new device improving the application of a supraacetabular anterior external fixator compared with other constructs. Material and Method. Synthetic pelvic models were used. Complete pelvic ring instability was created by symphyseal and unilateral sacroiliac joint disruption. Four different constructs of fixation were tested. A pressure-sensitive film was placed in the sacroiliac joint. The constructs were applied in a standardized way. The maximum sacroiliacal compression loads (N) of each trial was recorded. Statistics was performed with the student t-test. Results. Standard supraacetabular two-pin external fixator achieved a dorsal compression load of 13.84 (SD 8.13). The new dorsal pelvic compression device delivered 177.05N (SD 32.32) of load across the sacroiliac joint when the pins were inserted half way and 183.58N (SD 46.64) with full pin insertion. Both the half- and full-pin construct demonstrated a significant dorsal load improvement with the pelvic compressor (p<0.05) compared with the standard supraacetabular fixator group. The C-clamp revealed compression forces of 384.88N (SD 22.95), which was significantly greater than all the other groups (p<0.05). Conclusion. We tested a simple and new modular device for improved application of pelvic external fixation. The centres of rotation of supra-acetabular pins were determined and used to achieve greater dorsal compression forces in disrupted pelvic ring injuries. The compression load is less than with a C-Clamp, but significantly greater than the familiar technique of standard external supra-acetabular fixation. This improves the initial stability in acute management of unstable, disrupted and life threatening pelvic ring fractures

Purpose: Surgery is required for primary tumours invading the sacroiliac joint. The purpose of the present work was to analyse results obtained with surgical treatment in order to better ascertain indications. Material and methods: Forty patients (24 men and 16 women), mean age 24 years (range 12–56) underwent surgery for high-grade sarcoma (n=30, osteosarcoma 12, Ewing 13, chondrosarcoma five) or more differentiated tumours (n=10, low-grade S chondrosarcoma five, fibro-sarcoma two, others three). Resection was achieved in 37 cases via two approaches and via a lateral approach in three. Resection involved vertical sacrectomy either via the homolateral foramen (n=27) or via the midline (n=10). Reconstruction consisted in stabilising the iliosa-cral assembly generally associated with vertebral osteo-synthesis, an autologous graft in 36 cases, cement in one, and an allograft in three. Functional outcome was assessed with the MSTS (Enneking). Results: There were three infections (all three with extensive lateral approach) and five cases of postoperative lumbosacral trunk palsy. Late complications were three cases of spondylolisthesis and eight nonunions. Twenty patients died (eight local recurrences, ten metastases, one chemotherapy toxicity, one undetermined cause). Sixteen patients achieved complete remission at six years (follow-up 2–16 years) and four patients were lost to follow-up. Functional outcome was very good in eight, good in ten, fair in twelve, and poor in ten. Survival was 40% among patients with malignant tumours (38 patients) but only 20% for those with osteosarcomas. Discussion: Technical improvements (combined approach rather than wide lateral approach and omentum flap) have allowed a reduction of cutaneous and infectious complications. Mechanical complications can be prevented by systematic lumbosacral fusion on the side opposite the resection reconstruction. This provides good functional results despite sacrificing a hemi-sacral plexus if the lumbo-sacral trunk is preserved. Reconstruction after extension of the resection to the acetabulum raises an unresolved problem and yields mediocre results. The quality of the surgical resection is determinant since risk of local recurrence is 8/100 after a contaminated resection edge. Conclusion: Surgical resection of sacroiliac tumours is a source of numerous complications despite real technical improvements. This approach can be proposed if carcinological resection can be reasonably achieved. Local control is very poor in case of large osteo-osteogenic sarcomas

A prospective study was conducted to determine the functional and radiographic outcome of sacroiliac arthrodesis. Twenty patients were enrolled and the mean follow-up period was 4.6 years. SI joint instability was the most common etiology. Seventeen of twenty patients (85%) went on to a solid fusion. Statistically significant improvement was noted postoperatively in five of eight SF-36 categories (PF, RP, BP, SF, and RE), with a positive trend in the others. We conclude that sacroiliac arthrodesis is successful in the treatment of sacroiliac disorders, however its success is dependent on careful patient selection. The purpose of this study was to determine the functional and radiographic outcome of sacroiliac joint arthrodesis. Twenty consecutive patients were enrolled with an average age of 45.1 years. Plain radiographs and SF-36 Health Surveys were obtained prior to surgery and during the follow-up period. Mean duration of symptoms was 2.6 years and mean follow-up was 4.6 years. SI joint instability was the most common etiology and was present in twelve patients. Seventeen of Twenty (85%) patients went on to a solid fusion. Of the three patients who did not fuse, two remained symptomatic and required revision surgery. Fifteen of twenty patients (75%) completed pre- and post-operative SF-36 forms. Improvement was noted in all SF-36 categories. PF improved from 31.8±31.0 to 50.7±34.5 (p< 0.030). RP improved from a 0.0±0.0 to 31.3±41.5 (p< 0.012). BP improved from 15.6±11.1 to 35.7±24.7 (p< 0.009). SF improved from 37.5±21.0 to 61.5±24.1 (p< 0.028). Finally, RE improved from 46.2±48.2 to 66.7±44.9 (p< 0.012). Improvement was also noted in GH, VT, and MH from 52.2±23.5, 30.8±21.7, and 56.0±28.3, respectively to 56.1±20.5, 44.6±25.8, and 61.3±26.3, respectively, however these were not significant (p values 0.345, 0.064, and 0.220, respectively). In this prospective study, a fusion rate of 85% was achieved, and statistically significant improvement in functional outcome was observed in five of eight SF-36 categories with a positive trend in the others. Sacroiliac arthrodesis is successful in the treatment of SI joint instability, arthritis, spondyloarthropathy, and dysfunction, however, its success is dependent on careful patient selection

Dysfunction of the pelvic girdle causes alteration of the lumbopelvic muscle supporting function and thus disruption of the load transference through the pelvis. Walking loads symmetrically the muscles that provide stability to the pelvis for load transference and is an easy way to evaluate bilateral muscle function. The aim of this study was to find out if mobilisation of the symptomatic sacroiliac joint (SIJ) in chronic low back pain patients could alter the lumbopelvic muscle activity measured by surface EMG (sEMG) on the symptomatic side during walking. The resulting change in the muscle activity seemed to be relaxation of the muscles evaluated. The muscles whose activity changed for the most during walking after mobilization of the symptomatic SIJ were biceps femoris, on the right side 17,8% (p= 0.007) and on the left side 12.8% (p= 0.012). The right gluteus medius relaxed 14.4% (p=0.016) and left side 6.1% (p=0.033). Lumbar multifidi reacted more on the right side 14.5% (p=0.003) and on the left the decrease was 8.3% (p=0.021). Oblique abdominal externus muscles showed very little change after intervention. This study gives us the point of view that the main influence the mobilisation has on SIJ is neurophysiological, reflectoric on muscle tone

Purpose and background:. Sacroiliitis identified by MRI is considered as a keystone in the diagnosis of spondyloarthritis. To reduce the number of unnecessary MRI scans it would be ideal if sacroiliac (SI) joint pain provocation tests could be used to identify patients at risk of having sacroiliitis. The aim of the current study was to investigate the diagnostic value of three pain provocation SI-joint tests for sacroiliitis identified by MRI. Methods:. Patients (n=454, mean age 32 years, 54% women) without clinical signs of nerve root compression were selected from a cohort consisting of patients with persistent low back pain referred to an outpatient spine clinic. Data from the Gaenslen's Test, Thigh Thrust Test and Long Dorsal Sacroiliac Ligaments Test and sacroiliitis identified by MRI were analysed. Results:. The prevalence of SI-joints with sacroiliitis was 5%. In the whole study group, only the Thigh Trust Test was associated with sacroiliitis, ROC area 0.58 (95% CI 0.51–0.65), sensitivity 31% (18–47) and specificity 85% (82–87). In men, sacroiliitis was associated with all three SI joint tests and multitest regimens, with the greatest ROC area found for ≥ 1 positive out of 3 tests, (0.68 (0.56–0.80)), sensitivity 56% (31–79) and specificity 81% (77–85). In women, no significant associations were observed between the assessed SI joint tests and sacroiliitis. Conclusions:. Only in men were the performed SI-joint tests found to be associated with sacroiliitis identified by MRI. Although, the diagnostic value was limited, the results indicate that the use of SI joint tests for sacroiliitis may be optimised by gender-separated analyses

Introduction We report on the clinical and radiological outcomes and complications associated with percutaneous ilio-sacral screw fixation of the pelvis.

Methods Patients were located on the plevic data base held at Frenchay Hospital, Bristol, UK. Patient charts were reviewed and their clinical outcomes had been determined using a visual analogue (VAS) pain score. All patients had pre and post-operative x-rays and CT scans. These were used to determine fracture type and subsequent post-operative reduction. All complications and subsequent surgery required was noted.

Results One hundred and seven patients with 76 disruptions of the sacro-iliac joint and 62 sacral fractures treated with percutaneous ilio-sacral screws were reviewed. Average follow-up was 2.5 years (range 6 months to 8 years). Half of the patients had a VAS score of zero post-operatively, 30% had scores of one to five and 20% had scores of greater than five. The majority of these patients had a coexisting neurological lesion. Seventy-one percent had an anatomical reduction (within 5 mm), 18% had displacements of between five and 10 mm and 11% had displacements of greater than 10 mm. There were five infections, four sacral nonunions, four failures of fixation and one case of a transient L5 nerve plasy following inadvertent screw positioning.

Conclusions Percutaneous ilio-sacral screw fixation of the pelvis allows safe, reliable and accurate reduction. Poor clinical results are often attributable to coexisting neurological lesions.

Variations in pelvic anatomy are a major risk factor for misplaced percutaneous sacroiliac screws used to treat unstable posterior pelvic ring injuries. A better understanding of pelvic morphology improves preoperative planning and therefore minimises the risk of malpositioned screws, neurological or vascular injuries, failed fixation or malreduction. Hence a classification system which identifies the clinically important anatomical variations of the sacrum would improve communication among pelvic surgeons and inform treatment strategy. 300 Pelvic CT scans from skeletally mature trauma patients that did not have pre-existing posterior pelvic pathology were identified. Axial and coronal transosseous corridor widths at both S1 and S2 were recorded. Additionally, the S1 lateral mass angle were also calculated. Pelvises were classified based upon the sacroiliac joint (SIJ) height using the midpoint of the anterior cortex of L5 as a reference point. Four distinct types could be identified:. Type-A – SIJ height is above the midpoint of the anterior cortex of the L5 vertebra. Type-B – SIJ height is between the midpoint and the lowest point of the anterior cortex of the L5 vertebra. Type-C – SIJ height is below the lowest point of the anterior cortex of the L5 vertebra. Type-D – a subgroup for those with a lumbosacral transitional vertebra, in particular a sacralised L5. Differences in transosseous corridor widths and lateral mass angles between classification types were assessed using two-way ANOVAs. Type-B was the most common pelvic type followed by Type-A, Type-C, and Type-D. Significant differences in the axial and coronal corridors was observed for all pelvic types at each level. Lateral mass angles increased from Types-A to C, but were smaller in Type-D. This classification system offers a guide to surgeons navigating variable pelvic anatomy and understanding how it is associated with the differences in transosseous sacral corridors. It can assist surgeons’ preoperative planning of screw position, choice of fixation or the need for technological assistance

Introduction. A recent study to identify clinically meaningful benchmarks for gait improvement after total hip replacement (THA) has shown that the minimum clinically important improvement (MCII) in gait speed after THA is 0.32 m/sec. Currently, it remains to be investigated what preoperative factors link to suboptimal recovery of gait function after THA. This study aimed to identify preoperative lower-limb muscle predictors for gait speed improvement after THA for hip osteoarthritis. Method. This study enrolled 58 patients who underwent unilateral primary THA. Gait speed improvement was evaluated as the subtraction of preoperative speed from postoperative speed at 6 months after THA. Preoperative muscle composition of the glutei medius and minimus (Gmed+min) and the gluteus maximus (Gmax) was evaluated on a single axial computed tomography slice at the bottom end of the sacroiliac joint. Cross-sectional area ratio of individual composition to the total muscle was calculated. Result. The females (n=45) showed smaller total cross-sectional areas of the gluteal muscles than the males (n=13). Gmax in the females showed lower lean muscle mass area (LMM) and higher ratios of the intramuscular fat area and the intramuscular adipose tissue area to the total muscle area (TM) than that in the males. Regression analysis revealed that LMM/TM of Gmed+min may correlate negatively with postoperative improvement in gait speed. Receiver operating characteristic curve analysis for prediction of MCII in gait speed at ≥ 0.32 m/sec resulted in the highest area under the curve for Gmax TM with negative correlation. The explanatory variables of hip abductor muscle composition predicted gait speed improvement after THA more precisely in the females compared with the total group of both sexes. Conclusion. Preoperative Gmax TM could predict gait speed MCII after THA. Preoperative muscle composition should be evaluated separately based on sexes for achievement of clinically important improvement in gait speed after THA

Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular soft tissue injury is a documented, albeit sparse, etiology contributing to peri- and postpartum hip pain. Further research to better delineate the prevalence, mechanism of injury, natural history and management options for women suffering from these pathologies at an already challenging time is necessary to advance the care of these patients

Anteroposterior (AP) pelvic radiographs are the standard tool used for pre-operative planning and post-operative evaluation during total hip arthroplasty (THA). The accuracy of this imaging modality is, however, limited by errors in pelvic orientation and image distortion. Pelvic obliquity is corrected for by orienting measurements to a reference line such as the interteardrop line or the interischial line, while several methods for correcting for pelvic tilt have been suggested, with varying levels of success. To date, no reliable method for correcting for pelvic rotation on pelvic imaging is available. The purpose of this study was to evaluate a novel method for correcting pelvic rotation on a standard anteroposterior (AP) radiographs. Computed tomography (CT) scans from 10 male cadavers and 10 female THA patients were segmented using 3D Slicer and used to create 3D renderings for each pelvis. Synthetic AP radiographs were subsequently created from the 3D renderings, using XRaySim. For each pelvis, images representing pelvic rotation of 30° left to 30° right, at 5° increments were created. Four unique parameters based on pelvic landmarks were used to develop the correction method: i) the horizontal distance from the upper edge of the pubic symphysis to the sacroiliac joint midline (PSSI), ii) the ratio of the horizontal distances from the upper edge of the pubic symphysis to the outer lateral border of both obturator foramina (PSOF), iii) the width ratio of the obturator foramina (OFW) and iv) the ratio of the horizontal distance from each anterior superior iliac spine to the sacroiliac joint midline (ASISSI). The relationships between the chosen parameters and pelvic rotation were investigated using a series of 260 (13 per pelvis) synthetic AP radiographs. Male and female correction equations were generated from the observed relationships. Validation of the equations was done using a different set of 50 synthetic radiographs with known degrees of rotation. In males, the PSSI parameter was most reliable in measuring pelvic rotation. In females, PSOF was most reliable. A high correlation was noted between calculated and true rotation in both males and females (r=0.99 male, r=0.98 female). The mean difference from the male calculated rotation and true rotation value was 0.02°±1.8° while the mean difference from the female calculated rotation and true rotation value was −0.01°±1.5°. Our correction method for pelvic rotation using four pelvic parameters provides a reliable method for correcting pelvic rotation on AP radiographs. For any figures or tables, please contact authors directly

Purpose And Background: In patients with chronic low back pain (LBP), selective injection procedures (provocative discography, medial branch, facet and sacroiliac joint blocks) have shown the pain source to be the intervertebral disc in 40%, the sacroiliac joint in 13–19% and the facet joints in 15–40%. No individual features in the history or examination are of consistent discriminatory value in diagnosis. This study aimed to assess whether patients with different pain sources could be differentiated using the Oswestry Disability Index (ODI) (a validated patient questionnaire scoring ten different aspects of pain and function in patients with LBP; higher scores correlating with greater disability). Methods And Results: ODI scores were recorded from 67 patients (46 female, age 17–82) whose source of LBP was subsequently confirmed by selective injection. The scores for each section of the ODI were compared between patients grouped according to pain origin; disc (n=11), sacroiliac (n=31) or facet (n=25). Patients with disc pain had significantly greater overall disability and scored higher for sitting, sleeping and social activity than those with facet or sacroiliac pain as judged by the 95% confidence limits of the median (p< 0.05). Patients with facet pain scored higher for walking and standing compared to those with sacroiliac pain. For disc pain scores were higher for sitting and standing than for walking, and for facet pain scores were higher for standing than for sitting or walking. Conclusion: Although the ODI is not a diagnostic tool, analysis of its components reveals characteristic pain and disability patterns in patients sub-grouped according to pain source

Background. NICE guidance suggests that caudal epidural injections of steroid and local anaesthetic may be considered for acute and severe sciatica, however studies have demonstrated limited long-term benefit and impact on future surgery. This study aimed to investigate the use of caudal epidural injections in a district general hospital setting and the rate of subsequent operation. Methods. All patients undergoing caudal epidural injection between 1. st. January and 30. th. June 2015 were included. Records were reviewed to obtain diagnosis, pre- and post-epidural clinical findings, prior interventions, and subsequent operations. Results. A total of 141 patients underwent a caudal epidural, with a median age of 63 (18 – 90). 37 patients went on to surgical intervention within 3 years, resulting in a conversion rate of 26.1%. Amongst those not requiring surgery, 59 (56.19%) had disc herniation, 42 (40%) stenosis, 4 spondylolisthesis, and 1 a facet cyst. Pre-operatively 63.81% reported back pain and 93.33% sciatica. 39.05% of patients had sensorimotor changes. Post-operatively, 27.62% reported an improvement in their back pain, compared to 62.86% reporting improved leg pain. 36.59% of those with sensorimotor changes reported improvement. 32 later had a further caudal epidural or foraminal block, and 25 had facet and sacroiliac joint injections. Amongst those requiring surgery, 21 (56.76%) had disc herniation, 15 (40.54%) stenosis, and 1 spondylolisthesis (2.7%). Conclusion. In our series, approximately three quarters of patients undergoing caudal epidural injection did not subsequently require surgery. Lumbosacral radicular symptoms improved in two thirds, however the epidural was less effective at treating back pain. No conflicts of interest. No funding obtained