Protrusio Acetabuli: New Insights and Experience with Joint Preservation

  • Michael Leunig
  • Shane J. Nho
  • Luigino Turchetto
  • Reinhold Ganz
Symposium: Papers Presented at the Annual Closed Meeting of the International Hip Society

DOI: 10.1007/s11999-009-0853-3

Cite this article as:
Leunig, M., Nho, S.J., Turchetto, L. et al. Clin Orthop Relat Res (2009) 467: 2241. doi:10.1007/s11999-009-0853-3

Abstract

Protrusio acetabuli is identified on anteroposterior (AP) radiographs of the pelvis with an acetabular line projecting medial to the ilioischial line. We documented this radiographic sign and additional radiographic parameters in 19 patients (29 hips) with protrusio and compared the parameters to those of 29 older patients (29 hips) with advanced primary osteoarthritis (OA) but no protrusio and 12 younger patients (22 hips) with protrusio but no advanced OA. A negative acetabular roof angle and particularly large acetabular fossa were more apparent in younger patients; these hips suggest the destruction of a protrusio hip begins less in the medial joint area and more in the posteroinferior joint, and the mechanism is driven less by excessive medially directed forces but by a pincer impingement. While the indication for joint-preserving surgery currently consists primarily of a valgus femoral osteotomy based on AP radiographs and patient age, modern decision making also relies on cartilage evaluation and requires advanced surgical techniques. We conclude joint-preservation surgery must be tailored to the individual hip morphology.

Level of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Michael Leunig
    • 1
  • Shane J. Nho
    • 1
    • 2
  • Luigino Turchetto
    • 3
  • Reinhold Ganz
    • 4
  1. 1.Hip ServiceSchulthess ClinicZurichSwitzerland
  2. 2.Rush University Medical CenterChicagoUSA
  3. 3.Orthopaedic DepartmentVeneto Regional HospitalPortogruaroItaly
  4. 4.Orthopaedic DepartmentUniversity of BerneBerneSwitzerland

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