Sacroiliac joint stabilization using implants provide better fixation in females compared to males: a finite element analysis

Eur Spine J. 2021 Aug;30(8):2351-2359. doi: 10.1007/s00586-021-06863-8. Epub 2021 May 22.


Purpose: This study's objective was to assess biomechanical parameters across fused and contralateral sacroiliac joints (SIJs) and implants during all spinal motions for both sexes. Various SIJ implant devices on the market are used in minimally invasive surgeries. These implants are placed across the joint using different surgical approaches. The biomechanical effects of fusion surgical techniques in males and females have not been studied.

Methods: The validated finite element models of a male, and a female spine-pelvis-femur were unilaterally instrumented across the SIJ using three screws for two SIJ implants, half threaded and fully threaded screws placed laterally and posteriorly to the joint, respectively.

Results: Motion and peak stress data at the SIJs showed that the female model exhibited lower stresses and higher reduction in motion at the contralateral SIJ in all motions than the male model predictions with 84% and 71% reductions in motion and stresses across the SIJ.

Conclusion: Implants exhibited higher stresses in the female model compared to the male model. However, chances of SIJ implant failure in the female patients are still minimal, based on the calculated factor of safety which is still very high. Both lateral and posterior surgical approaches were effective in both sexes; however, the lateral approach may provide a better biomechanical response, especially for females. Moreover, implant design characteristics did not make a difference in the implants' biomechanical performance. SIJ stabilization was primarily provided by the implants which were the farthest from the sacrum rotation center.

Keywords: Finite element analysis; Fusion; Sacroiliac joint; Sex; Surgical approach.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Biomechanical Phenomena
  • Female
  • Finite Element Analysis
  • Humans
  • Low Back Pain*
  • Male
  • Minimally Invasive Surgical Procedures
  • Prostheses and Implants
  • Sacroiliac Joint* / surgery