Revision sacroiliac joint fusion: mid-term patient-reported outcomes

Sacroiliac joint (SIJ) fusion is an accepted management strategy of SIJ dysfunction. However, revision SIJ fusion (RSIJF) may be required in up to 12 percent of cases, and data are limited regarding patient outcomes following RSIJF. This study analyzes the clinical, radiographic, and patient-reported outcomes (PROs) after RSIJF.

A retrospective review was conducted of patients who underwent RSIJF from 2017 to 2024. All RSIJF utilized a principles-based approach: joint decortication, bone grafting, compression, and rigid stability. PROs at preoperative, 6-month, 1-year, and 2-year follow-up timepoints were recorded for Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Single Assessment Numeric Evaluation (SANE), Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI), and PROMIS Physical Function (PF). Fusion was assessed by computed tomography (CT) after ≥1 year.

A total of 62 RSIJF were performed in 48 patients. SANE scores demonstrated sustained improvement across 6-month to 2-year timepoints (64.6% vs. 69.2%, P=0.74). ODI score improvement was significant at all timepoints (P<0.001). Postoperative PF and PI scores demonstrated improvement at the 1- and 2-year timepoints (P≤0.03). NPRS scores dropped significantly at all timepoints (P≤0.004). Five SI joints (8%) underwent reoperation for implant removal (n=2), antirotation screw removal (n=2), and continued pain (n=1). Available CT imaging demonstrated definitive bridging bone observed in 92% of cases. There were no occurrences of radiolucency or implant migration.

RSIJF offers sustained moderate improvements in pain and function, as evidenced by PROs at extended follow-up. Improvements were moderate, highlighting a difficult diagnosis and patient population commonly endorsing multiple pain generators.