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Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis

March 15, 2015

Contributors: Manuel Ribas Fernandez, MD; Nicole Matsuda; Benjamin G. Domb, MD; Dean K Matsuda, MD; Dean K Matsuda, MD

INTRODUCTION: Osteitis pubis (OP) is a form of athletic pubalgia associated with femoroacetabular impingement (FAI). Surgical options include open curettage and, more recently, endoscopic pubic symphysectomy. To our knowledge, this is the first and largest series to date on this topic of interest and we introduce the surgical technique in an editted video. The purpose of this study is to determine outcomes from endoscopic pubic symphysectomy for the treatment of athletic osteitis pubis performed in the typical setting of concurrent FAI surgery. The purpose of our video is to enlighten surgeons of this new technique, instruct them on how to perform the procedure safely and effectively, and share mid-term outcomes.

METHODS: A multicenter retrospective case series was performed of seven consecutive adult patients (four male) of mean age 33 years with symptomatic FAI and OP that underwent arthroscopic surgery for the former and endoscopic pubic symphysectomy for the latter with mean follow up of 2.9 years (range, 2.0-5.0 years). Visual analogue scale (VAS), nonarthritic hip scores (NAHS), and patient satisfaction were measured. Complications and revision surgeries were reported and pre and postoperative radiographs were assessed. Ths endoscopic surgical technique is presented in a concise manner highlighting key steps, pearls, and pitfalls.RESULTS: Mean preoperative VAS of 6.7 (range, 8-4) improved to a mean postoperative VAS of 1.5 (range, 7-0) (P=0.03). Mean preoperative NAHS of 50.2 (range, 21-78) improved to a mean postoperative NAHS of 84.7 (range, 41-99) (P=0.03). Mean patient satisfaction was 8.3 (range, 3-10). Two male patients had postoperative scrotal edema which resolved spontaneously. There were no other complications. Pre and postoperative radiographs demonstrated no anterior or posterior pelvic ring instability. One patient underwent pubic symphyseal arthrodesis because of continued pain.

CONCLUSION: Endoscopic pubic symphysectomy may provide clinical benefit for recalcitrant osteitis pubis associated with femoroacetabular impingement. It is technically within the grasp of most arthroscopic surgeons and may be performed concurrently with surgery for FAI. Male patients should be counseled that scrotal swelling may occur as a complication.

Results for "Hip Preservation"

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