Sacroiliac pain after total hip arthroplasty: a combined analysis of clinical data and three-dimensional imaging in standing and sitting positions

Patients frequently complain of low back pain and sacroiliac joint pain (SIP) following total hip arthroplasty (THA). We hypothesized that patients with SIP would display different pelvic incidence (PI) values between standing and relaxed sitting positions, indicative of increased motion in the sacroiliac joints.

In this retrospective case-control study, 94 patients who underwent unilateral THA and experienced SIP were compared with 94 control patients without SIP. SIP was confirmed through clinical tests and investigated using biplanar imaging in both standing and sitting positions. The key parameters analyzed included PI, sacral slope (SS), lumbar lordosis (LL), and limb length discrepancy (LLD).

Patients without SIP showed a mean difference in PI of -1.5° (-8°–5°) between standing-to-sitting positions, whereas those with SIP showed a difference of -3.3° (-12°–0°)(P < 0.0001), indicating more motion in the sacroiliac joint during daily activities in the latter group. Patients with SIP showed smaller change in LL between standing-to-sitting positions (mean:6.3°; range:-8°–27°) compared with those without SIP (mean:9.5°; range:-12°–28°)(P = 0.006). No significant differences were noted in functional leg length between patients with (mean:7 mm; range:0–12 mm) and without SIP (mean:7 mm; range:0–11 mm)(P = 0.973).

This study revealed significant sacroiliac joint motion in patients with SIP post-THA, as indicated by PI changes, increased posterior pelvic tilt, and reduced change in the LL. Contrary to common belief, SIP did not correlate with LLD.