Related Experiment Video
Updated: May 13, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Is Sacro-iliac Joint Degeneration Associated With Inferior Outcome Post-Total Hip Arthroplasty?
Koorosh Kashanian1, Roman P Austin2, Sebastian Mavromatis1
1Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario.
Insights
Hip osteoarthritis (OA) often co-occurs with sacroiliac joint (SIJ) OA. This study found a high prevalence of SIJ OA in total hip arthroplasty (THA) patients, but SIJ OA did not impact THA outcomes.
Area of Science:
- Orthopedics
- Radiology
- Rheumatology
Background:
- Hip osteoarthritis (OA) is frequently linked to adjacent joint degeneration, including the sacroiliac joint (SIJ).
- Understanding the prevalence and impact of SIJ OA in patients undergoing total hip arthroplasty (THA) is crucial for comprehensive patient care.
Purpose of the Study:
- To determine the prevalence of SIJ OA in patients scheduled for THA.
- To investigate the association between the severity of hip OA and SIJ OA.
- To evaluate the relationship between SIJ OA severity and patient outcomes after THA.
Main Methods:
- Retrospective analysis of 1,154 THA cases from two academic centers (2018-2022).
- Preoperative radiographs assessed for hip OA (Tönnis grade) and SIJ OA (Modified New York criteria).
- Patient-reported outcomes measured using Oxford Hip Score (OHS) and EuroQol 5-Dimension (EQ-5D) pre- and post-operatively.
Main Results:
- A high prevalence of advanced SIJ OA was observed (39.3% mNYC grade 3, 1.4% mNYC grade 4).
- A weak but significant association was found between hip OA severity (Tönnis grade) and SIJ OA (mNYC) (ρ = 0.19, P = 0.047).
- No significant difference in 1-year OHS was associated with the degree of hip or SIJ OA, after adjusting for baseline factors.
Conclusions:
- Sacroiliac joint pathology is common in patients with hip osteoarthritis undergoing THA.
- Despite a weak association between hip and SIJ OA severity, SIJ OA does not appear to influence THA outcomes.
- Treatment decisions for hip OA should not be primarily guided by the presence or severity of concurrent SIJ OA.
Background:
Osteoarthritis (OA) of the hip is known to be associated with OA in adjacent areas such as the sacro-iliac joint (SIJ). This study aimed to: 1) describe the prevalence of SIJ OA in a cohort of patients undergoing total hip arthroplasty (THA), 2) test for an association between the degree of hip OA and SIJ OA, and 3) examine if the degree of SIJ OA is associated with outcomes post-THA.
Methods:
This is a retrospective analysis of prospective databases from two tertiary academic centers. There were 1,154 THA cases from 2018 to 2022. The mean age and body mass index were 67 years and 28.7, respectively. Preoperative radiographs were assessed for hip OA via the Tönnis grade, with 0 being the lowest severity and 3 being the highest. The SIJ OA was graded using the Modified New York criteria (mNYC), ranging from 0: normal to 4: ankylosis. All patients had pre and postoperative Oxford Hip Score (OHS) measurements, with follow up at 1 year. A subset of 589 patients also had 5-level EuroQol 5-Dimension pre- and postoperative as a lifestyle measure. Complications, reoperations, and revisions were recorded. Data were analyzed using Statistical Analysis System version 9.4 (SAS Institute Inc., Cary, North Carolina, USA).
Results:
There was a high prevalence of advanced SIJ OA, with 39.3% (453) mNYC three cases and 1.4% (16) mNYC four cases. The association between Tönnis grade and mNYC was weak but significant (ρ = 0.19, P = 0.047). There was no difference in OHS at 1 year when accounting for age, hip OA, or baseline OHS (P < 0.216).
Conclusions:
There is a high prevalence of SIJ pathology in patients undergoing THA, but a weak association between SIJ and hip OA. The SIJ pathology and outcomes following THA had no association, indicating that for patients presenting with concurrent hip and SIJ OA, the SIJ should not direct treatment.
