Late Posterior Instability of the Pelvis after Resection of the Symphysis Pubis for the Treatment of Osteitis Pubis. A Report of Two Cases*

Inflammation of the symphysis pubis, commonly known as osteitis pubis, is a painful disorder of uncertain etiology. The onset of osteitis pubis has frequently been reported after urological or gynecological procedures and is associated with a number of conditions, including trauma, rheumatological disorders, pregnancy, and parturition3,6,8,9,12,15. In most patients, symptoms of osteitis pubis resolve spontaneously; however, a small number of patients have pain that persists indefinitely. Resection of the symphysis has been recommended for the treatment of osteitis pubis that is unresponsive to non-operative management. Several authors have reported early relief of symptoms with this procedure; however, the long-term effect of resection of the symphysis on the integrity of the ligaments of the sacroiliac joint is of concern3,6,14. We report on two patients in whom debilitating posterior instability of the pelvis developed and necessitated operative stabilization twelve and eighteen years after wedge resection of the symphysis pubis for the treatment of osteitis pubis. CASE 1. A forty-two-year-old woman was involved in a skiing accident in 1978. At the time of the injury, the patient noted immediate pain in the area of the symphysis pubis. The pain gradually increased over the next six weeks, prompting her to seek medical attention. Osteitis pubis was subsequently diagnosed, but the patient was not offered any non-operative treatment. One month after she was seen, she was managed with wedge resection of the symphysis pubis, including the entire symphyseal joint and a total of fifteen millimeters of bone. Initially, the symptoms decreased; however, over the next five years the patient noted the onset of low-back pain centered over the sacroiliac joints. The symptoms were managed non-operatively with repeated injections of corticosteroids and oral administration of non-steroidal anti-inflammatory medications, …