Prognostic role of affected side of the sacroiliac joint in pain recurrence after total hip arthroplasty with prior manual correction of iliosacral dislocation: prospective randomized clinical study

Introduction

Degenerative changes in the hip joint as indications for operative treatment are observed in more than a third of the population over the age 50. In most cases, the development of a degenerative process in the hip joint is accompanied by changes in the sacroiliac joint. To improve the quality of life, relieve pain, and improve the clinical outcomes of rehabilitation after total hip arthroplasty (THA), an integrated approach should be chosen.

Materials and methods

Eighty-four patients were enrolled in a prospective randomized study, between 2017 and 2020. The patients were randomly (with the use of computer) divided into two groups (42 to group I, 42 to group II). The first group of patients underwent surgery using a new technique that included intra-operative manual correction of iliosacral dislocation of the sacroiliac joint, whilst the second group of patients underwent THA according to the standard protocol. All groups of patients underwent THA. Clinical treatment outcomes were assessed with the use of the Visual Analogue Scale (VAS) and the Harris Hip Score (HHS). Kaplan–Meier estimator was constructed to determine the differences in the probability of recurrence of pain syndrome depending on the side of the dislocated sacroiliac joint. NCT04673747 (ClinicalTrials.gov identifier).

Results

There was a significant pain relief and an improvement in the quality of life of patients who underwent intra-operative manual correction of sacroiliac joint dislocation compared with the group of patients who underwent standard THA.

Conclusion

The use of intra-operative manual correction of sacroiliac joint dislocation can lead to a pronounced improvement in the quality of life of patients, pain decrease, and an improvement in rehabilitation of patients after performing THA. According to the analysis of statistical data, a potential risk factor for recurrence of pain, is the presence of dislocation on the contralateral side from the operated joint.