Orthopedic Surgery

March 29, 2025

A Mayo Clinic orthopedic surgeon specializing in trauma has designed a surgical repair for osteitis pubis, a condition for which most patients are told to go home, rest and take an aspirin. Osteitis pubis results from pubic symphysis joint inflammation, causing pain where the two pelvic bones meet and in the surrounding region.

"Until now, nobody has had a good answer for osteitis pubis," says William W. Cross III, M.D., who practices at Mayo Clinic in Minnesota and says pelvic pain comprises two-thirds of his patient load. "There's a misconception that there's no cure. This condition is rare and historically treated nonsurgically, with physicians putting patients in the chronic pain pathway for relief."

Further, Dr. Cross says there is a paucity of scientific research about osteitis pubis, which he describes as a post-traumatic or overuse injury. No rigorous epidemiological studies exist for this condition, and only small case series are in the medical literature. From his practice and research, Dr. Cross also anecdotally finds that more women than men are affected by this condition.

Currently, after failure of all conservative measures, Dr. Cross operates on patients with osteitis pubis using a selective debridement of the pubic symphysis through a mini Pfannenstiel incision — a smaller version of the incision used for c-section. He then resects several millimeters of bone from each symphysis where the inflammation causes the pelvic bones to crowd each other and leads to bone grinding. This involves creating a new space in the pubic symphysis joint — just enough to provide relief to the area without causing destabilization. His experience shows that this surgery has helped eligible patients with the condition.

"We've tried to minimize morbidity and have worked on this procedure to treat osteitis pubis with minimally invasive techniques," he says. "We have a good track record of treating osteitis pubis where nothing else has helped."

Patients who develop osteitis pubis and eligibility for surgery

Patients who experience osteitis pubis include those who have:

• Participated in high-impact athletics. Those who play sports involving significant force, such as hockey and soccer, are especially at risk of the condition.
• Recently delivered a baby. Dr. Cross says many of his patients are postpartum. Typically, the bones at the pubic symphysis open for delivery, but for these patients the bones do not come back together properly.
• Experienced trauma. In a motor vehicle crash, for example, the pelvis can burst open, says Dr. Cross.

Osteitis pubis symptoms arise with activity, whether that means going for a run or rolling over in bed. The pain with this condition can radiate into the groin and the medial thigh, and patients typically experience pain while walking.

"Patients with osteitis pubis usually are dramatically limited in what they can do," says Dr. Cross. "They have pain nearly all the time and can't do the things they used to do anymore: They can't run, and they are not hiking anymore. So this is really a quality-of-life surgery — getting patients back doing the things they want to do."

Factors that increase a patient's risk of developing osteitis pubis are unpredictable, indicates Dr. Cross.

All patients with osteitis pubis do not qualify for surgery, says Dr. Cross. Eligibility is based on:

• Medical history. Patients must have a history consistent with anterior pelvic ring pain.
• Tenderness in the pelvic region. On physical exam by the surgeon, the patient notes severe point tenderness over the pubic symphysis.
• Edema. Physicians notice swelling prompted by excess fluid trapped in the body's tissues near the pelvic symphysis in imaging results.
• Injection response. Physicians perform a diagnostic injection into the pubic symphysis in patients with suspected osteitis pubis. A positive response to this injection helps confirm this area as a primary pain generator.
• Failed nonsurgical treatment. At times, nonsurgical treatment is unsuccessful and the swelling and pain linger.

For many patients, including some postpartum patients, surgery is unnecessary, with the condition dissipating over time.

Referring a patient for surgical evaluation

Dr. Cross believes that obstetricians and primary healthcare professionals may encounter patients with osteitis pubis. The key to helping these patients, however, is awareness of this pathology to recognize the condition and familiarity with all available treatments, including surgical repair.

"The eyes only see what the mind knows," he says. "If healthcare professionals are not considering osteitis pubis when a patient presents with pelvic ring pain, they don't see it."

He encourages physicians to keep osteitis pubis in their differential diagnoses, as inaccurate diagnoses can lead to delayed treatment.

"There is hope when osteitis pubis is properly identified and treated," says Dr. Cross. "These patients go from being told that nothing can be done for them to having an operation with only a mini-incision, which typically fixes the condition. And they do well postsurgically: The deep-seated pain is almost immediately gone, and they can go back to sports and enjoying life."

He says that he sees clinical improvement in days for patients who have this surgery — and he often sees a difference the same day as surgery.

Dr. Cross says that Mayo Clinic in Minnesota is unique in its experience with this procedure to treat patients with osteitis pubis through such a minimalist open approach. Therefore, he suggests referral of patients diagnosed with this condition or suspicious for this condition to Mayo Clinic.

For more information

Refer a patient to Mayo Clinic.