Paper of the month March 2023

Effect of Sacroiliac Joint Pain on Outcomes in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up.
Am J Sports Med. 2022 Aug;50(10):2606-2612.

^{Horner NS, Rice MW, Sivasundaram L, Ephron CG, Nho SJ.
Investigation performed at Rush University Medical Center, Chicago, Illinois, USA}

This paper showed that patients with femoroacetabular impingement syndrome (FAIS) and coexisting sacroiliac joint (SIJ) pain had slightly worse patient-reported outcomes after arthroscopic hip surgery.

The SIJ and the hip joint are closely related. In particular, the recent development of hip arthroscopy has led to the discovery of FAI and related hip labral injuries that were previously unrecognized. Prior to the discovery of these hip pathologies, when I saw a patient with SIJ dysfunction complaining of groin pain, I considered the groin pain to be referred pain from the SIJ because I thought there was no hip joint degenerative change based on conventional imaging such as x-rays. However, I now know that hip labral injuries may accompany SIJ dysfunction.

This paper has a limitation for identifying SIJ pain because they did not perform diagnostic SIJ injections, however, it is interesting that hip surgeons are paying great attention to SIJ pain well and performed SIJ provocation tests.

One of my colleagues can perform arthroscopic hip surgery. Since I started working with him, I have made new discoveries in my clinical practice, especially in SIJ and spine surgery.

I was very happy to see a young female patient with severe SIJ pain who was a candidate for SIJ fusion surgery, but after hip arthroscopy surgery, her SIJ pain gradually improved and she was able to successfully return to work and even get married.

I envied hip surgeons who have an ability to do hip arthroscopy because they can restore the function of the joint. SIJ fusion surgery cannot restore SIJ function. If there is a lesion in the hip joint that can be treated, it should be given priority, and in cases of severe SIJ pain, we must always consider complications of hip joint disorders. Many SIJ pain provocation tests are designed to stress the SIJ through the hip joint. I often do the Fabere test and the Fadirf test, but I am now doing both the anterior and posterior hip impingement test to identify hip joint dysfunction.

Fortunately, SIMEG has a hip surgeon, Dr. Martin Blay, as a member.

I think it would be good to study the relationship between the SIJ and the hip joint while interacting with an international group of hip arthroscopists.

In the future, I would like to arrange a meeting where we are able to share findings in each special experience including physical examination techniques face to face.

Daisuke Kurosawa