Stand-Alone Sacroiliac-Joint Fusion as Novel Treatment Approach for Septic Arthritis of the Pubic Symphysis

Management of septic arthritis of the pubic symphysis (SAS) presents with substantial clinical challenges. Firstly, the SAS is an extremely rare entity. Surgical resection of the symphysis plus targeted antibiotic therapy is a widely adopted treatment course. Some patients suffering from SAS develop posterior pelvic insufficiency fractures because of the weakened anterior pelvic ring or as a result of radiation therapy received during treatment for a malignant disease in the lesser pelvis. The literature demonstrates a lack of standardized strategies for restoring pelvic ring integrity based on pelvic instability and posterior pelvic insufficiency fractures caused by SAS. Background and Objectives: This study aimed to determine whether early, primary stand-alone dorsal fusion can be a viable treatment option in SAS and whether there is a clinical benefit compared with temporary anterior fixation or secondary posterior stabilization after failed anterior fixation. Materials and Methods: We performed a descriptive, retrospective analysis covering an eight-year period (2018-2025) including 21 patients who underwent symphyseal resection for destructive SAS. We evaluated peri- and postsurgical data to describe the different surgical methods and their respective outcomes. Results: Ten patients (10/21, 48%) received posterior stabilization (sacroiliac-joint fusion or spinopelvic stabilization). Seven patients (7/21, 33%) were anteriorly fixated either temporarily with an external fixator or permanently with ventral plate osteosynthesis. Four patients (4/21, 19%) did not receive any pelvic stabilization following symphyseal resection as pelvic integrity was present. Three of them (3/21, 14%) showed spontaneous sacroiliac-joint fusion, while 6/7 (86%) of anteriorly fixed patients presented with debilitating sacral insufficiency fractures, had longer hospital stays and a higher count of readmissions and re-operations. Primary posterior stabilization led to shorter hospital stays, less readmissions, and good clinical outcome. Conclusions: Primary posterior stabilization can be a viable course of treatment of SAS and should be considered especially when spontaneous sacroiliac-joint fusion is not present. We suggest that early stabilization of the posterior pelvic ring could be a sensible course of treatment and may prevent debilitating insufficient fractures. While there are many different surgical options for posterior stabilization available (spinopelvic/lumbosacral stabilization, sacroiliac-joint fusion and others), our preliminary data suggest that primary sacroiliac-joint fusion is a quick, minimally invasive and effective way to establish posterior pelvic stability.