FP10.6 Frequency of Sacroiliac Joint Pathology in Patients with Femoroacetabular Impingement

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ID: 331255
2026
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Abstract
Abstract ICLA10 - Unraveling the Failure: Diagnostic Algorithms and Why Hip Preservation Fails, Auditorium A (BMCC Level 1), October 9, 2026, 10:30 - 12:30 Purpose Coexisting low back pain is an established predictor of poor outcomes in patients with femoroacetabular impingement (FAI), yet the source of this pain frequently remains unidentified. Sacroiliac (SI) joint pathology represents a potentially overlooked contributor — one that not only shares symptom overlap with FAI but may also indicate underlying inflammatory conditions such as axial spondyloarthritis (axSpA). Despite these clinical implications, the frequency of SI joint pathology in patients with FAI has not been systematically quantified. This study aimed to investigate the frequency of SI joint pathology and axSpA in a large cohort of patients with FAI. Methods We retrospectively analysed the electronic records and imaging of 951 patients with FAI who were referred to our tertiary hip preservation service for surgical intervention between January 2007 and December 2022. Inclusion criteria comprised skeletal maturity and a clinical and radiological diagnosis of FAI. Pincer morphology was defined by lateral centre-edge angle >40° or crossover sign, while cam morphology was defined by alpha angle >55°. Low back pain was defined as patient-reported lumbar pain lasting ≥3 months. SI joint pathology was confirmed on MRI scan by a musculoskeletal radiologist, and axSpA was diagnosed by rheumatologists using the ASAS classification criteria. Results Of the 951 patients, 613 met the inclusion criteria. Amongst these 613 patients with FAI (43.9% male, mean age 39.7 ± 11.3 years), 141 (23.0%) reported low back pain, with a higher frequency in males than females (29.7% vs 17.7%). SI joint pathology was identified in 35 patients (5.7%) and axSpA was diagnosed in 10 patients (1.6%) of the total cohort. Amongst patients with FAI and low back pain, the frequency of SI joint pathology was 24.8% (35/141) and frequency of axSpA was 7.1% (10/141). Conclusion A quarter of patients with FAI and low back pain have associated SI joint pathology, and 7.1% meet diagnostic criteria for axSpA. These findings highlight that FAI should not be evaluated in isolation — routine screening for SI joint pathology and axSpA should be considered in patients with FAI presenting with low back pain, and may have meaningful implications for surgical planning and outcome optimisation.
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Authors Sonia E Ubong, Teresa Araujo, Vikas Khanduja
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.078
URL
https://doi.org/10.1093/jhps/hnag043.078
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