The sacroiliac joint is a major weight-bearing joint interposed between the hip and the spine. Its vulnerability to injury and disease-related processes can lead to painful, irreversible changes of the sacroiliac joint, requiring surgical arthrodesis. Many surgical methods have been described for ablation of the sacroiliac joint, yet controversies surround reliable healing, imaging and confirmation of effective joint ablation. This article provides a historical review of sacroiliac joint arthrodesis techniques presented in the literature. The data are presented in three sections: overview of diagnostic methods, surgical and perioperative methods, and outcomes. A critique of each method is presented chronologically, and reasons for lack of progress or failure explored. A new method of surgical arthrodesis by calibrated distraction and grafting interposition of the joint/recess is presented.

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The sacroiliac joint (SIJ) is a highly studied but controversial area of orthopaedic diagnosis and treatment. Previous literature suggests that injuries and degeneration follow the patterns of other joints, and much is understood about its anatomic relationships, biomechanics and presentation. Nevertheless, historical literature has not resulted in a consensus on a standard method of diagnosis, or agreement on nonsurgical or surgical management. The diagnostic injection, although helpful, may support the diagnosis when present, but does not replace a cautious physical examination or exploration of other important findings. New methods of imaging and surgical treatment are reminders that answers for this difficult problem may be on the horizon.

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