Case Studies
SI Joint Pain Masked As Hip Pain for 10 Years
“A diagnosis that is often present but rarely detected.”
*Consultant for SI-BONE, Inc.
- Provider
- Robert Limoni, M.D.*
- Speciality
- Orthopedic Surgery Froedtert & Medical College of Wisconsin
- Facility
- Medical College of Wisconsin
- Bio
-
Residency: Grand Rapids Medical Education & Research Center, Grand Rapids, MI Medical School: Medical College of Wisconsin, Milwaukee, WI. Dr. Limoni is a board-certified Orthopedic Surgeon specializing in total joint replacement procedures and hip and knee surgeries.
Patient History:
- 10-year history of left posterior hip pain
- Initial diagnosis determined by MRI was a superior labral tear with a pincer lesion
- Managed by multiple providers including hip arthroscopy specialist, joint arthroplasty surgeon and interventional pain specialist
Treatment History:
- Hip arthroscopy and rim trimming with no resolution of posterior hip pain
- Underwent a second hip arthroscopy a year later and still no resolution of posterior hip pain
- Referred for total hip arthroplasty (THA) with no pain improvement 3 months post-op
- Subsequently referred to interventional pain management for SI joint injections which provided short durations of posterior hip pain relief over the course of 5 years
- Patient returned to her hip surgeon who performed a CT scan of the pelvis which showed no problems with the THA. Note degenerative changes in the left SI joint.
- Patient went for a second opinion to Dr. Limoni who performed a thorough SI joint evaluation
Through history, physical exam and positive response to diagnostic injections, the left SI joint was determined to be her pain generator.
Surgical Treatment:
- MIS SI joint fusion with iFuse TORQ® was performed
PostOp:
- Patient had marked pain improvement at 6-week follow-up1,2
1Patient results may vary
2Data on file, STACI Study, SI-BONE, Inc.
Discussion:
The diagnosis and treatment of hip pain should include history, physical examination and diagnostic imaging. Femoral Acetabular Impingement (FAI) can certainly cause direct damage to the labrum and joint margins, however, excess force transfer to the pelvis on impingement of the hip also occurs. FAI caused solely or in combination by hip dysplasia, arthritic hip spurs, or reduced pelvic mobility from spine stiffness can lead to symptomatic pain in the pubic symphysis and SI joint in earlier stages and lead to radiographic degeneration of these adjacent joints in later stages. Hip surgeons, therefore, need to be adept in physical examination of the SI Joint and encompass this as part of their differential.
Healthcare professionals should refer to the Instructions For Use for indications, contraindications, warnings, and precautions at https://si-bone.com/label.
There are potential risks associated with iFuse procedures. They may not be appropriate for all patients and all patients may not benefit.
For information about the risks, visit https://si-bone.com/risks.