Endoscopic pubic symphysectomy for reclacitrant osteitis pubis associated with bilateral femoroacetabular impingement.
This is the first reported case of the completely endoscopic management of osteitis pubis with pubic symphysectomy. A 31-year-old woman suffered from recalcitrant osteitis pubis that had progressed to an end-stage auto-fused condition. Ossified pubic symphyseal fibrocartilage and adjacent heterotopic bone were endoscopically removed as part of a comprehensive surgery that also involved bilateral arthroscopic surgery for symptomatic femoroacetabular impingement. An innovative dual-portal (anterior and supra-pubic) endoscopic technique is presented along with the rationale for the preservation of the inferior (arcuate) pubic ligament and the posterior pubic ligament. Twelve months following this single-stage surgery, the patient reported high satisfaction with decreased pain, improved function, and resolution of a classic waddling gait. The association of intra-articular hip pathology with osteitis pubis is noted. We believe that this minimally invasive bone-conserving surgery may be useful in the management of recalcitrant osteitis pubis and perhaps find broader application in the outpatient endoscopic treatment of athletes afflicted with this condition.
Matsuda
Dean K
DK
Department of Orthopedics, Southern California Permanente Medical Group, 6041 Cadillac Ave, Los Angeles, CA 90034, USA. dean.k.matsuda@kp.org
D000328:Adult; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D057925:Femoracetabular Impingement / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010000:Osteitis / Q000473:pathology* / Q000601:surgery*; D011630:Pubic Bone / Q000473:pathology* / Q000601:surgery*; D011631:Pubic Symphysis / Q000473:pathology / Q000601:surgery; D013567:Symphysiotomy / Q000379:methods*; D016896:Treatment Outcome