Summary

Endoscopic pubic symphysectomy for recalcitrant cases of osteitis pubis yielded significant improvement in mHHS, NAHS, and iHOT-12, and a high patient satisfaction, reaching clinical important thresholds at a high rate at a minimum 2-year follow-up.

Abstract

Background

Osteitis pubis is an idiopathic inflammatory condition that affects the pubic symphysis and surrounding soft tissues, believed to result from overuse, trauma, or functional anterior instability of the pelvis. This study aims to evaluate the outcomes of endoscopic pubic symphysectomy as a treatment for refractory cases of osteitis pubis, with a minimum 2-year follow-up. A secondary aim is to present a return-to-sport sub-analysis of this patient population.

Methods

Prospectively collected data was retrospectively analyzed for all patients who underwent patients who underwent endoscopic pubic symphysectomy as treatment for osteitis pubis between May 2012 and September 2021. Included patients had completed pre-operative and minimum of 2-year postoperative questionnaires for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12) and Visual Analogue Scale (VAS) and patient satisfaction. The MCID was calculated for the mentioned PROs and included in the analysis. Preoperative and postoperative sports participation were accounted for in a sub-analysis.

Results

A total of 14 patients were included in the study. All patients experienced symptom relief with a significant improvement in mHHS, NAHS, iHOT-12, and a high patient satisfaction rate. Furthermore, a high percentage of patients reached the calculated MCID for mHHS, NAHS, HOS-SSS, and iHOT 12. Twelve patients (85.7%) reported participating in sports within one year prior to surgery, with 9 patients (75%) able to return to sport within one year post surgery.

Conclusion

Endoscopic pubic symphysectomy for recalcitrant cases of osteitis pubis yielded significant improvement in mHHS, NAHS, and iHOT-12, and a high patient satisfaction, reaching clinical important thresholds at a high rate at a minimum 2-year follow-up. Remarkably, 75% of patients were able to return to sport participation within one year of the surgery.