Primary Protrusion of the Acetabulum

Hooper, Jonathan C.; Jones, E. W.

doi:10.1302/0301-620x.53b1.23

Cited by 34 publications

(22 citation statements)

References 5 publications

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“…It can even lead to an amplification of a potential conflict between the posteroinferior femoral head-neck junction and the posterior horn of the acetabulum [17,18]. This might explain the variability of reported results ranging from promising midterm results [21] to sobering results after short-term followup [12]. There is only one previous report [17] of open acetabular rim trimming and two case reports [20,30] of a total of six cases with arthroscopic circumferential rim trimming.…”

Section: Discussionmentioning

confidence: 99%

“…1) [17,44]. The acetabulum usually presents with an excessively increased size of the lunate surface [40], which in turn leads to excessive femoral coverage [44] with a lateral center-edge angle typically exceeding 39° [12,47]. Protrusio acetabuli has been described as the most severe representation of pincer-type femoroacetabular impingement (FAI) [18].…”

Section: Introductionmentioning

confidence: 99%

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Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup

Hanke

Steppacher

Zurmühle

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincertype femoroacetabular impingement (FAI); however, to our knowledge, there are no published mid-or long-term studies on results of circumferential acetabular rim trimming through a surgical hip dislocation for patients with this condition. Questions/purposes (1) What is the 10-year survivorship of the hips treated with circumferential rim trimming through a surgical hip dislocation compared with a control group of hips that underwent surgery for pincer FAI but that did not have protrusio acetabuli? (2) What are the factors that were associated with a decreased likelihood of survivorship in those hips with the following endpoints: total hip arthroplasty, Merle d'Aubigné score of less than 15, and/or radiographic progression of osteoarthritis (OA)? (3) Does the radiographic pattern of degeneration differ between the two groups?Methods We performed a case-control study comparing two groups: a protrusio group (32 patients [39 hips]) and a control group (66 patients [86 hips]). The control group consisted of hips treated with a surgical hip dislocation for pincer FAI and did not include hips with a positive protrusio sign or a lateral center-edge angle [ 39°. The study group did not differ from the control group regarding the preoperative Tönnis OA score, age, and body mass index. However, the study group had more women, decreased mean height and weight, and lower preoperative Merle d'Aubigné-Postel scores, which were inherent differences at the time of first presentation. During the period in question, the indication for performing these procedures was a painfully restricted range of motion in flexion and internal rotation (positive impingement sign). The mean followup of the protrusio group (9 ± 5 years [range, 2-18 years]) did not differ from the control group (11 ± 1 years [range, 10-13 years], p = 0.109). At the respective minimum followup intervals in the underlying database from which cases and control subjects were drawn, followup was 100% for patients with protrusion who underwent FAI surgery and 97% for patients with FAI who underwent surgery for other anatomic patterns (three of 86 hips). We assessed the Merle d'Aubigné-Postel score, Harris hip score, WOMAC, and UCLA activity score at latest followup. A Kaplan-Meier survivorship analysis of the hip was calculated if any of the following endpoints for both groups occurred: conversion to total hip arthroplasty, a Merle d'Aubigné-Postel score \ 15, and/or radiographic progression of OA. Differences in survivorship were analyzed using the log-rank test. Results At 10-year followup, we found a decreased survivorship of the hip for the protrusio group (51% [95% confidence interval {CI}, 34%-67%]) compared with the control group (83% [95% CI, 75%-91%], p \ 0.001) with -016-4918-9 Clinical Orthopaedics and Related Research ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup

Hanke

Steppacher

Zurmühle

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Various radiological methods have been used to evaluate this complication in adults [2,10,13,19]. To our knowledge no systematic evaluation of the normal bony landmarks has been undertaken in children in order to detect protrusio in its earliest stages.…”

Section: Discussionmentioning

confidence: 99%

“…jection of a bony bulge inside the pelvic cavity [13], the presence ofa Wiberg's centre edge (CE) angle greater than 45 ~ [19], the presence of crossed and reversed teardrop [10], and recently the crossing of the acetabular line medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women [2]. This last method has proved to be more reliable in measurement of protrusio than previous methods.…”

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confidence: 99%

Evaluation of the measurement methods for protrusio acetabuli in normal children

et al. 1990

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The normal values of the radiological lines most frequently used as references in the diagnosis of adult protrusio acetabuli were prospectively determined in 150 children (300 hips) without femoral pathology and aged between 2 and 15 years, mean age 8 years. The teardrop shape was modified according to the child's age, the "crossed" type predominating (48.7%). The mean centre edge (CE) angle fluctuated, with a median value of 31.2 degrees +/- 6.2 degrees, increasing with age and with slightly greater values in females; a large spread of CE angle values was observed within age groups. Acetabular ilioischial line values ranged from +7 to -5 mm, with a mean of +1.8 +/- 2 mm. This last method was the most suitable because it was not modified by changes in incidence of X-rays in radiological studies. With this method protrusio is diagnosed in children when the acetabular line is projected medially, provided that the ilioischial line is 1 or 3 mm or more for boys and girls, respectively. We conclude that the most trustworthy method available to evaluate PA in children should be "line crossing".

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“…A protrusão acetabular foi inicialmente descrita em 1824 por Adolph William Otto, patologista alemão, por meio de estudos realizados em cadáveres, como uma deformidade da parede medial do acetábulo, com consequente migração da cabeça femoral para o interior da pelve [1][2][3][4][5][6] .…”

Section: Introductionunclassified

Classificação angular para protrusão acetabular utilizada no serviço de ortopedia da Faculdade de Medicina do ABC

Miashiro

Chikude

Yamaguchi

et al. 2010

Arq. Bras. Ciên. Saúde

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ResumoIntrodução: a protrusão acetabular foi inicialmente descrita por Otto, em 1824. A incidência é maior no sexo feminino e a bilateralidade, mais comum, é maior nas protrusões de etiologia primária. Sotelo-Garza e Charnley definiram uma classificação que considera a distância da parede medial em relação à linha de Köhler.Objetivo: apresentar a classificação angular para protrusão acetabular e demonstrar sua aplicabilidade. Método: a classificação da Faculdade de Medicina do ABC (FMABC) foi determinada a partir da medida do ângulo P (ângulo de protrusão), formado pela intersecção de três linhas. Foram avaliadas radiografias de bacia em dois grupos de pacientes: o primeiro, com pacientes sem protrusão acetabular, em que foram definidos os valores de normalidade, e o segundo, com pacientes com protrusão acetabular. Destes, foram medidos o ângulo P e o tamanho da protrusão de acordo com Sotelo-Garza e Charnley, sendo os resultados comparados. Dezenove quadris com protrusão foram submetidos à artroplastia total e comparados os valores do ângulo P no pré e pós-operatório. Resultados: o valor médio do ângulo P, em pacientes sem protrusão acetabular, foi -1,22°. No segundo grupo, observou-se semelhança quando foram comparados os valores da classificação FMABC e os da classificação de Sotelo-Garza e Charnley. A comparação entre os valores do ângulo P pré e pós-operatórios resultou em diferença estatisticamente significante (p<0,001). A classificação angular foi dividida em leve, moderada e grave. Conclusões: o ângulo P foi sempre superior a zero nas protrusões acetabulares, os valores numéricos das duas classificações foram estatisticamente significativos, possibilitando a utilização dos mesmos valores da classificação de Sotello-Garza e Charnley para a classificação FMABC, e o uso de enxerto causou uma lateralização do componente acetabular. Palavras-chave:Deformidades articulares adquiridas; acetábulo; artroplastia. AbstractIntroduction: protrusio acetabuli was first described by Otto, in 1824. Its incidence is higher among women and the bilaterality, more common, is higher in

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Primary Protrusion of the Acetabulum

Cited by 34 publications

References 5 publications

Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup

Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup

Evaluation of the measurement methods for protrusio acetabuli in normal children

Classificação angular para protrusão acetabular utilizada no serviço de ortopedia da Faculdade de Medicina do ABC

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