Osteitis pubis has been originally described in patients’ following suprapubic surgery for urological or gynecological pathologic modalities and remains a well-known complication of invasive procedures of the pelvic area. Although it represents a common cause of pain in athletes, particularly soccer players, it has often been reported after trauma, rheumatic disorders, pregnancy and parturition . It can affect all age groups; however it is rarely encountered in the pediatric population. Literature data reports that it occurs most commonly in men aged between 30 to 50 years. Women are affected more in their mid 30s .
Nowadays, the disease is regarded as a non-infectious inflammation of the pubic symphysis leading to varying degrees of lower abdominal and pelvic pain. Pain is localized over the pubic symphysis and may radiate to the groin, medial thigh, or abdomen . Differential diagnosis mandates special attention since the disease has to be distinguished from pubic osteomyelitis
Radiographs
AP of pelvis:
AP pelvis shows osteolytic pubis with bony erosions and often times diastasis of the symphysis
degenerative changes within the joint can be seen
There is a radiographic latent period after the onset of symptoms of one to three weeks; however, some patients will never manifest definitive radiologic changes. When present, the findings may simulate joint infectionThe most characteristic radiographic appearance is a bilateral and usually symmetric involvement of the pubic bone and adjacent rami. Irregularity of the joint margin, subchondral sclerosis, and a moth-eaten type of osteoporosis, with widening of the joint space can be striking. With resolution, there is reconstitution of normal bone density, but the joint margin frequently remains irregular and may even be ankylosed.
MRI:
bone marrow edema found early
Bone scan:
increased activity in area of pubic symphysis
Differential:
Athletic pubalgia
Stress fracture of the pubic rami
Stress fracture of the femoral neck
Inguinal hernia
Oncologic disease (rare)
treatment
Nonoperative
NSAIDS, rest, activity modification
indications
treatment for vast majority of cases
modalities
steroid injections are controversial
outcomes
self-limiting process which usually resolves with non-operative treatment
may take several months to resolve
Different surgical techniques have been described in the literature, including curettage, arthrodesis, wedge resection, wide resection as well as endoscopic pubic symphysiectomy.