Skip to main content
SpringerLink
Log in

Total Hip Arthroplasty for Protrusio Acetabuli: Principles of Reconstruction and Technique

  • Chapter
  • First Online:
Hip Arthroplasty

  • 188 Accesses

Abstract

Protrusio acetabuli (PA) is characterized by superior and medial migration of the femoral head into the pelvis secondary to trauma or disease. Degenerative arthritis is a common sequelae of fatigue failure of the medial wall in PA hips, and total hip arthroplasty (THA) is the treatment of choice for optimal restoration of the centre of rotation (COR) and biomechanics of these hips. THA for PA poses specific technical challenges, viz. difficult exposure, difficult dislocation, specific reaming protocol, distalization and lateralization of the COR and optimal fixation of the socket. Meticulous pre-operative planning coupled with a step-by-step approach is the key to a successful outcome. The chief determinants include restoration of the acetabular bone stock and adequate lateralization and distalization of the COR of the native hip. The choice of fixation is either cemented or biological, depending upon the severity of the condition and the extent of acetabular bone loss. Protrusio support devices and anti-protrusio cages (APCs) may be required in extreme cases as they help bridge areas of severe bony deficiencies, allowing bone grafts to be incorporated. However, they are expensive and may sometimes not match the nature of the bony defect. Special reconstruction techniques, viz. acetabular distraction are needed in certain specific acetabular defects such as pelvic discontinuity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Armbuster TG, Guerra J, Resnick D, Goergen TG, Feingold ML, Niwayama G, et al. The adult hip: an anatomic study. Part I: the bony landmarks. Radiology. 1978;128(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  2. Guerra J Jr, Armbuster TG, Resnick D, Goergen TG, Feingold ML, Niwayama G, Danzig LA. The adult hip: an anatomic study. Part II: the soft-tissue landmarks. Radiology. 1978;128:11–20.

    Article  PubMed  Google Scholar 

  3. Otto AW. Ein Becken, mit kugelformig augedehnten Pfannen. In: Heft E, editor. Seltene Beobachtungen zur Anatomie, Physiologie und Pathologie gehorig, vol. IX. Breslau: Verlag Willibald August Holaufer; 1816. p. 19–20.

    Google Scholar 

  4. Hastings DE, Parker SM. Protrusio acetabuli in rheumatoid arthritis. Clin Orthop Relat Res. 1975;108:76–83.

    Article  Google Scholar 

  5. Eppinger H. Pelvis-Chrobak; Coxarthrolisthesis – Becken. Beitr Geburtsh Gynak. 1903;2:176.

    Google Scholar 

  6. Freidenberg N. The normal CE angle of normal hips. Acta Orthop Scand. 1976;47:403.

    Article  Google Scholar 

  7. Freidenberg ZB. Protrusio Acetabuli in childhood. J Bone Joint Surg. 1963;45:373.

    Article  Google Scholar 

  8. Overgaard K. Otto’s disease and other forms of Protrusio Acetabuli: primary juvenile osteo-asthenic protrusion and secondary protrusions. Acta Radiol. 1935;os-16(3):390–410.

    Google Scholar 

  9. Gilmour J. Adolescent deformities of the acetabulum an investigation into the nature of protrusio acetabuli. BJS (British Journal of Surgery). 1939;26(104):670–99.

    Article  Google Scholar 

  10. McCollum DE, Nunley JA, Harrelson JM. Bone-grafting in total hip replacement for acetabular protrusion. J Bone Joint Surg Am. 1980;62(7):1065–73.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. Leunig M, Nho SJ, Turchetto L, Ganz R. Protrusio acetabuli: new insights and experience with joint preservation. Clin Orthop Relat Res. 2009;467(9):2241–50.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Crowninshield RD, Brand RA, Pedersen DR. A stress analysis of acetabular reconstruction in protrusio acetabuli. J Bone Joint Surg Am. 1983;65(4):495–9.

    Article  CAS  PubMed  Google Scholar 

  14. Mullaji AB, Marawar SV. Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups: a medium-term radiographic review. J Arthroplast. 2007;22(8):1143–9.

    Article  Google Scholar 

  15. Mullaji A, Shetty G. Acetabular protrusio: surgical technique of dealing with a problem in depth. Bone Jt J. 2013;95-B:37–40.

    Article  CAS  Google Scholar 

  16. Sotelo-Garza A, Charnley J. The results of Charnley arthroplasty of hip performed for protrusio acetabuli. Clin Orthop Relat Res. 1978;132:12–8.

    Google Scholar 

  17. Eftekhar NS. Total hip arthroplasty. St. Louis: Mosby; 1993. p. 1038.

    Google Scholar 

  18. Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980;62(7):1059–65.

    Article  CAS  PubMed  Google Scholar 

  19. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast. 1994;9(1):33–44.

    Article  CAS  Google Scholar 

  20. Pereira GCT, Kubiak EN, Levine B, Chen FS, Di Cesare PE. Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups. Int Orthop. 2007;31(4):445–50.

    Article  CAS  PubMed  Google Scholar 

  21. Baghdadi YMK, Larson AN, Sierra RJ. Restoration of the hip center during THA performed for Protrusio Acetabuli is associated with better implant survival. Clin Orthop Relat Res. 2013;471(10):3251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Archibeck MJ, Rosenberg AG, Berger RA, Silverton CD. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg. 2003;11(3):163–73.

    Article  PubMed  Google Scholar 

  23. Harkess JW, Crockarell JR Jr. Arthroplasty of the hip. In: Canale ST, Beaty JH, editors. Campbell's operative Orthopaedics. 12th ed. Philadelphia: Elsevier; 2013. p. 209–11.

    Google Scholar 

  24. Rosenberg WW, Schreurs BW, de Waal Malefijt MC, Veth RP, Slooff TJ. Impacted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis: an 8- to 18-year follow-up study of 36 hips. Acta Orthop Scand. 2000;71(2):143–6.

    Article  CAS  PubMed  Google Scholar 

  25. Welten ML, Schreurs BW, Buma P, Verdonschot N, Slooff TJ. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty: a 10- to 17-year follow-up study. J Arthroplast. 2000;15(7):819–24.

    Article  CAS  Google Scholar 

  26. Sporer SM, O’Rourke M, Paprosky WG. The treatment of pelvic discontinuity during acetabular revision. J Arthroplast. 2005;20(4 Suppl 2):79–84.

    Article  Google Scholar 

  27. Abdel MP, Trousdale RT, Berry DJ. Pelvic discontinuity associated with Total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2017;25(5):330–8.

    Article  PubMed  Google Scholar 

  28. Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg (Br). 1992;74-B(5):711.

    Article  Google Scholar 

  29. Gill TJ, Sledge JB, Müller ME. The Bürch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg (Br). 1998;80(6):946–53.

    Article  CAS  PubMed  Google Scholar 

  30. Pomeranz MM. Intrapelvic protrusion of the acetabulum (Otto pelvis). 1932. Clin Orthop Relat Res. 2007 Dec;465:6–15.

    Article  PubMed  Google Scholar 

  31. Lu N, Yang Y, Chen H, Li WQ, Pu B, Liu LP. Health-type total hip arthroplasty combined with compression bone grafting for rheumatoid arthritis with acetabular retraction. Chinese J Recon Surg. 2015;29:160–2.

    Google Scholar 

  32. Do T, Giampietro PF, Burke SW, Davis JG, Raggio C, Schneider R, et al. The incidence of protrusio acetabuli in Marfan’s syndrome and its relationship to bone mineral density. J Pediatr Orthop. 2000;20(6):718–21.

    Article  CAS  PubMed  Google Scholar 

  33. D’Arcy K, Ansell BM, Bywaters EG. A family with primary protrusio acetabuli. Ann Rheum Dis. 1978;37(1):53–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ranawat CS, Zahn MG. Role of bone grafting in correction of protrusio acetabuli by total hip arthroplasty. J Arthroplast. 1986;1(2):131–7.

    Article  CAS  Google Scholar 

  35. Garcia-Cimbrelo E, Diaz-Martin A, Madero R, Munera L. Loosening of the cup after low-friction arthroplasty in patients with acetabular protrusion. The importance of the position of the cup. J Bone Joint Surg (Br). 2000;82(1):108–15.

    Article  CAS  PubMed  Google Scholar 

  36. Zhen P, Li X, Zhou S, Lu H, Chen H, Liu J. Total hip arthroplasty to treat acetabular protrusions secondary to rheumatoid arthritis. J Orthop Surg Res. 2018;13(1):92.

    Article  PubMed  PubMed Central  Google Scholar 

  37. John JF, Fisher PE. Radiographic determination of the anatomic hip joint center. A cadaver study. Acta Orthop Scand. 1994;65(5):509–10.

    Article  CAS  PubMed  Google Scholar 

  38. Pierchon F, Migaud H, Duquennoy A, Fontaine C. Radiologic evaluation of the rotation center of the hip. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(4):281–4.

    CAS  PubMed  Google Scholar 

  39. Busch VJJF, Gardeniers JWM, Verdonschot N, Slooff TJJH, Schreurs BW. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg Am. 2011;93(4):367–71.

    Article  PubMed  Google Scholar 

  40. Krushell RJ, Fingeroth RJ, Gelling B. Primary total hip arthroplasty using a dual-geometry cup to treat protrusio acetabuli. J Arthroplast. 2008;23(8):1128–31.

    Article  Google Scholar 

  41. Regis D, Sandri A, Bonetti I. Acetabular reconstruction with the Burch-Schneider antiprotrusio cage and bulk allografts: minimum 10-year follow-up results. Biomed Res Int. 2014;2014:194076.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. AIIMS Jodhpur, Jodhpur, India

    Abhay Elhence, Sumit Banerjee & Akshat Gupta

Authors
  1. Abhay Elhence
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sumit Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akshat Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Head of Orthopedics and Joint Replacement, Amrita Institute of Medical Sciences Amrita Vishwavidyapeetham, Faridabad, India

    Mrinal Sharma

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Elhence, A., Banerjee, S., Gupta, A. (2023). Total Hip Arthroplasty for Protrusio Acetabuli: Principles of Reconstruction and Technique. In: Sharma, M. (eds) Hip Arthroplasty. Springer, Singapore. https://doi.org/10.1007/978-981-99-5517-6_20

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-5517-6_20

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-5516-9

  • Online ISBN: 978-981-99-5517-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation