Surgical treatment of sacroiliac joint infection

Sacroiliac joint infection is rare and frequently missed; purpose of this study is to describe the clinical presentations, comorbidities, laboratory and imaging findings, surgical options and outcomes of this rare condition.

We reviewed all cases of surgical treatment of sacroiliac joint infection operated at our institution between January 1994 and December 2011. Twenty-two patients were included: 14 females and 8 males, with mean age of 50 years. The mean follow-up period was 34 months. Twenty-four operations were performed. Coinciding infection was found in 11 cases (50 %). Twelve patients (54.5 %) presented acutely, while ten patients (45.5 %) had chronic infection.

Tuberculous infection was diagnosed in 5 cases and nonspecific infection in 13 cases. In four cases, no organism was isolated. Eleven cases were subjected to debridement only, while debridement and arthrodesis was needed in 11 cases. Eight patients had excellent clinical results, five good, three fair and four poor; one patient was lost to follow-up, and one patient died after 2 weeks. The operative technique depended on the course of the infection, bone destruction and general condition of the patient. There was a significant change in C-reactive protein and erythrocyte sedimentation rate preoperatively and 6 weeks postoperatively, while the difference in white blood cell count was nonsignificant.

In acute cases, the primary aim should be to save joint integrity by early debridement, depending on joint destruction and general patient condition. When it is chronic, it is not secure only to debride the joint, which should be fused.