Protrusio Acetabuli: Diagnosis and Treatment

Protrusio Acetabuli: New Insights and Experience with Joint Preservation

“…Dynamic gadolinium MRI of cartilage may also be useful to evaluate the degree of cartilage degeneration, but these studies may not be available at most institutions. Together with intraoperative findings of surgical hip dislocation in protrusion hips, we propose that that chronic impingement, especially its contre coup destruction of the cartilage in the posterior joint, initiates the osteoarthritic process of the protrusio hip rather than the pathologic medializing forces as discussed in the literature [7,18,19,22]. The precise amount of posterior cartilage injury is not known, but additional prospective studies will attempt to determine the effect of cartilage destruction on the clinical outcome.…”

“…We describe the morphologic characteristics in hips with protrusio acetabuli with an acetabular line measuring 3 mm in males and 6 mm in females medial to the ilioischial line [ 1,2,7,13,19]. In the protrusio acetabuli OA group, other parameters, especially the lateral center edge angle, the roof angle, and the extrusion index but also the topography of joint space narrowing, differed from those in the control OA group; however, such pathological values have not necessarily correlated with protrusion and may occur in a normal population [2].…”

“…These studies have been used to determine whether pathomorphological aspects can be better visualized than with AP pelvic radiographs alone and have currently been used to guide treatment for joint-preservation surgery [19,21,22]. Furthermore, the radiographic findings of previously operated hips from this group have been correlated to the intraoperative pathology observed during routine surgical hip dislocation [9].…”

“…Surgical closure of the triradiate cartilage has been proposed for the skeletally immature hip [29]; however, this approach has not been widely adopted, in part because of the inability to predict which hips will undergo progressive protrusion. Valgus intertrochanteric osteotomy has also been recommended in the young adult under the age of 40 years without the presence of arthritic changes [7,19,24].…”

Report of Breakout Session: Coxa Profunda/Protrusio Management

“…For the young adult, valgus intertrochanteric proximal femoral osteotomy has been recommended [5]. In the older adult, this procedure may provide an acceptable result if there is minimal arthritis.…”