Protrusio acetabuli

Revision Total Hip
with bone loss

1. Protrusio Acetabuli arthrokatadysis Dr.Ghazwan A. Hasan 5 th year Arab Board Trainee

2. Definition Is a hip joint deformity in which the medial wall of the acetabulum invades into the pelvic cavity, with associated medial displacement of the femoral head. It is caused by primary idiopathic and secondary neoplastic, infectious, metabolic, inflammatory, traumatic, and genetic disorders. 1 st case was published by Adolph William Otto, a German pathologist, in 1824 ( ( the right acetabulum protrudes into the pelvis like half an orange )) In 1854, Gurlt blamed acetabular fractures as the cause of the deformity, referring to it as ‘a coxalgia with acetabular fracture.

3. Etiology 1ry 2ndary Infectious ( Gonococcus, Echinococcus, Staphylococcus, Streptococcus, Mycobacterium tuberculosis). Neoplastic (Hemangioma, Metastatic carcinoma, Neurofibromatosis Radiation-induced osteonecrosis. Inflammatory ( Rheumatoid arthritis, Ankylosing spondylitis, Juvenile rheumatoid arthritis, Psoriatic arthritis, Acute idiopathic chondrolysis, Reiterís syndrome, Osteolysis , following hip replacement). Metabolic ( Pagetís disease, Osteogenesis imperfecta , Acrodysostosis , Osteomalacia Hyperparathyroidism ) Traumatic ( Sequelae of acetabular fracture Surgical error during hip replacement) Genetic ( Trichorhinophalangeal syndrome Stickler syndrome, Trisomy 18, Ehler - Danlos syndrome, Marfan syndrome, Sickle cell disease).

4. Diagnosis Clinical: Radiological:

5. Classification Sotelo -Garza and Charnley used the ilioischial line on an AP radiograph of the pelvis as a reference point from which to measure the location of the acetabulum.

6. Treatment Identification and treatment of any underlying disease process. Surgical Option is based on the patientís age and skeletal maturity and the extent of degenerative changes visualized on plain radiographs. Skeletally Immature patients: Surgical Closure of Triradiate cartilage +/- VITO .

7. Treatment Adolescent or Young Adult Patients: VITO by Pauwels

8. Treatment Older Adult Patients: VITO , THA Total hip arthroplasty is the recommended treatment for the older adult with protrusio acetabuli and degenerative changes. Ranawat et al reported on 35 hips with protrusio acetabuli secondary to rheumatoid arthritis that had been treated with cemented THA and had been followed up for an average of 4.3 years. They reported loosening in 16 of 17 hips recon- structed with the cup center more than 10 mm from the anatomic center . Of the 13 hips reconstructed with the cup center within 5 mm of the anatomic center, none was loose .

9. Treatment Bayley et al and Gates et al confirmed the importance of restoring the hip to an anatomic center . They noted that 50% of reconstructed hips with a cup center more than 10 mm from the anatomic hip center had failed. Ranawat and Zahn have recommended the following guidelines: In cases in which the protrusion is less than 5 mm, bone graft is not required. When the protrusion is greater than 5 mm and there is an intact medial wall, bone graft without augmentation devices is appropriate. If there is gross deficiency of the medial wall, bone graft with consideration of additional fixation devices (hemispherical non-cemented cup with screw supplementation or antiprotrusio ring) is indicated.

10. Treatment Ring Hip Prosthesis.

11. Cementless Cup Technique McBride MT, Muldoon MP, Santore RF, Trousdale RT, Wenger DR. Protrusio acetabuli : diagnosis and treatment. J Am Acad Orthop Surg. 2001; 9(2):79-88. Kroeber M, Ries MD, Suzuki Y, Renowitzky G, Ashford F, Lotz J. Impact biomechanics and pelvic deformation during insertion of press-fit acetabular cups. J Arthroplasty . 2002; 17(3):349-354.

12. Case Presentation 52 years old female History of RTA presented with pelvic fracture 4 months ago. Treated conservatively Presented with pain, Limitation of movement of Right Hip.

13. Post OPerative