Original Research
Management of Persistent Postpartum Pelvic Pain
Am J Orthop. 2008 December;37(12):621-626
Author and Disclosure Information
Yoram A. Weil, MD, Christian Hierholzer, MD, Domenico Sama, MD, Christopher Wright, BS, Markku T. Nousiainen, MD, FRCS(C), Peter Kloen, MD, and David L. Helfet, MD
Dr. Weil is Attending Orthopedic Surgeon, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Dr. Hierholzer is Attending Orthopedic Surgeon, BG-Unfallklinik Murnau, Murnau, Germany.
Dr. Sama is Attending Orthopaedic Surgeon, Orthopaedic and Trauma Unit, Vignola Civil Hospital, Modena, Italy.
Mr. Wright is PGY-2 Medical Student, New Jersey Medical School, Newark, New Jersey.
Dr. Nousiainen is Attending Orthopaedic Surgeon, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
Dr. Kloen is Attending Orthopedic Surgeon, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Netherlands.
Dr. Helfet is Professor of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York, and Director, Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, New York, New York.
Persistent postpartum pelvic pain is an uncommon but disabling disorder. Although symptoms resolve spontaneously in the majority of cases, some carefully selected women with this chronic condition might benefit from surgical stabilization of the pelvic ring.
We retrospectively studied 19 patients whose persistent postpartum pelvic pain was treated at our center. Although most patients were successfully treated nonoperatively, 6 (31.5%) underwent surgery because of symptoms persisting more than 1 year. Imaging studies, including magnetic resonance imaging, were used to assess the extent and the nature of the lesion before surgery. Eleven patients had degenerative changes in the anterior pelvic ring; the other 8 patients had degenerative sacroiliac joint changes. Surgical procedures included resection of the diseased fragment, anterior symphyseal plating, and bone grafting with and without posterior ring stabilization. For all patients, mean Majeed outcome score was 85 (range, 46-100). No significant difference in outcomes was found between the surgically treated patients and the nonoperatively treated patients.