Papers presented at the annual closed meeting of the international hip society protrusio acetabuli new insights and experience with joint preservation michael leunig md, shane j. Protrusio acetabuli is the migration of the femoral head along the femoral neck axis, medially and proximally, through the medial acetabular wall into the pelvis. 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. In this case the acetabulum has given way and there is medial migration of the femoral head. May be graded as mild 1 to 5 mm, moderate 6 to 15 mm, or severe 15 mm, with reference from the ilioischial line. The disease can be idiopathic primary or can be secondary to a number of conditions, such as trauma, inflammation or other diseases. The anterior column is the larger of the 2 columns.
Radiographic measurements in protrusio acetabuli herbert s. Protrusio acetabuli, described by otto in 1816, is a disorder in whichthe acetabulum andfemoral head are displaced medially into the pelvic cavity. Radiographic measurements in protrusio acetabuli sciencedirect. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged.
Latest hip replacement options benefits young patients with hip arthritis. It may be secondary to other disorders affecting the hip. Learningradiology acetabular, protrusio, acetabuli, paget. Idiopathic protrusio acetabuli is an uncommon disease process with both primary idiopathic and secondary forms. Protrusio acetabuli in juvenile rheumatoid arthritis pdf.
The 2 columns are described as having the shape of an inverted y, or of the greek letter lambda l. Acetabulum fractures need evaluation comprehensively by xrays and ct scans. The fissure in the cartlidge communicates with the supra acetabular portion of the left innominate bone which extends to the subchondral bone. The hip bone of the pelvic bonegirdle is composed of three bones, the ilium, the ischium and the pubis. Acetabular protrusio and proximal femur fractures in. In addition, we hypothesized that there would be a correlation between ap and proximal femur fracture incidence. It begins at the iliac wing and extends down the anterior portion of the acetabulum to incorporate the superior pubic ramus. The reinforcement rings or antiprotrusio cages are fi xed with cancellous screws.
The lce angle is typically superior to 40 degrees, the anterior and posterior wall indexes are increased, 99, 100 and the ai angle equals or is inferior to zero. Jun 20, 2016 a fifth elemental fracture divides the acetabulum transversely into superior and inferior components and extends across both of the columns. It is composed of three bones, the ilium, the ischium and the pubis. Radiology is a fundamental contribution in the diagnostic process. Acetabular protrusion is a more severe condition that occurs when the. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses.
In his 1993 book, letournel described the acetabular column principle. In the search for an etiology responsible for the primary protrusio group, most investigators have referred to the mechanisms responsible for secondary protrusio. Mcbride mt1, muldoon mp, santore rf, trousdale rt, wenger dr. Diagnosis of protrusio is established, if the medial wall of the acetabulum is 3 mm or more medial to the ilioischial line in men or 6 mm medial to it in women. The socket is too deep and may protrude into the pelvis. The anterior column of the acetabulum includes most of the iliac wing, the anterior acetabulum, and the superior pubic ramus. Ct of the hips in the investigation of protrusio acetabuli in marfan.
If you would like a large, unwatermarked image for your web page or. Evaluation of the measurement methods for protrusio acetabuli in. For example, the bone can break straight across the socket or shatter into many pieces. While the exact etiology remains obscure, primary protrusio acetabuli is a developmental condition with hereditary and racial influences. Protrusio acetabuli the cool way of saying acetabular protrusion. Protrusio acetabuli associated with marfan syndrome omim 154700 and ehlersdanlos syndromes has been linked with intrinsic weakness of the bone fast et al.
Using kulmans method to determine the presence of protrusio, we analysed the pelvic xrays of 15 patients with marfans syndrome and 15 controls. All the term protrusio means is that the floor of the acetabulum or socket has worn to such a degree that the femoral head is about to break through into the pelvic cavity. Thus, the five elemental patterns are anterior column, posterior column, anterior wall, posterior wall, and transverse fig. The aetiology of primary protrusio acetabuli the british. The epub format uses ebook readers, which have several ease of reading. Protrusio acetabuli, juvenile rheumatoid arthritis, hip arthritis. Protrusio acetabuli syndrome omim rr school of nursing. All had a preponderance of the syndromes cardinal features positive pedigree and musculoskeleta, ocular, and cardiovascular.
For this same photo without the arrows, click here. I have had issues with this hip offon since my twenties but mostly bursitis type things that once had to be treated with cortisone. Walter mercer 6 in his textbook, orthopedic surgery, describes a case by. There is bilateral acetabular protrusio white arrows. We retrospectively compared the radiographic parameters in 19 patients 29 hips with acetabular protrusio who underwent total hip replacement for secondary oa protrusio oa group to those in two groups of patients. You may not embed one of our images on your web page without a link back to our site. The femoral head should not extend medial to a line drawn from the medial aspect of the pelvis wall and the lateral aspect of the obturator foramen. Protrusio acetabuli in seronegative spondyloarthropathy by s i m 6 n e. Radiology not only provides assessment of injury, it helps choose best possible approach for stabilization, if indicated references.
Its frequency and clinical features in seronegative sponyloarthropathy snsa are unknown. Protrusio acetabuli is an uncommon defect of the acetabulum. The distance between the acetabulum and the ilioischial line yellow arrow should not be 3mm in males and 6 mm in females. Acetabular protrusio also known as acetabular protrusion is intrapelvic displacement of the acetabulum and femoral head, so that the femoral head projects medial to the ischioilial line. Nov 03, 2012 i have acetabular protrusio bilaterally with the left hip remarkably worse versus the right. Twelve patients were lost to followup feb 04, 2012 normally on an ap radiograph the medial wall of the acetabulum lies 2 mm lateral to the ilioischial line in a male and 1 mm medial to this line in a female. It should be differentiated from protrusio acetabuli, where the femoral head is seen additionally medial to the ilioischial line. Protrusio acetabuli centeredge ce angle 60 degrees, teardrop collapsed, and pelvis invaded by acetabulum beyond ilioischial line kohlers was identified in 22 patients with classic. R the bone loss of the acetabulum is reconstructed with morsellised allograft and impacted with a cup trial. It is caused by primary idiopathic and secondary neoplastic, infectious, metabolic, inflammatory, traumatic, and genetic disorders. Open reduction internal fixation using a combination of pelvic brim and infrapectineal plates. The triradiate cartilage closure is effective in reversing or stopping the protrusio before 10 years of age 1. M a l d o n a d o cocco protrusio acetabuli pa is a complication of many disorders involving the hip joint.
Nho md, ms, luigino turchetto md, reinhold ganz md published online. Aug 20, 2012 protrusio acetabuli the cool way of saying acetabular protrusion. Protrusio acetabuli definition of protrusio acetabuli by. Protrusio acetabuli in seronegative spondyloarthropathy. Protrusio acetabuli my protrusio mnemonics protrusio acetabuli includes the most common causes p. Characterized by progressive protrusio in middle aged women. Primary protrusio acetabuli in childhood springerlink. A fully developed hip joint is present by 8 weeks gestation. Cardiac radiology genitourinary radiology learning radiology. Primary protrusio acetabuli remains a diagnosis of exclusion, and as such many of the cases reported in the past may have in fact been secondary to undiagnosed conditions.
Global overcoverage consists of concentric deepening of the acetabulum acetabular dome breaching the pelvic brim which presents as coxa profunda or protrusio acetabuli. Early diagnosis and treatment reduce longterm disability and secondary osteoarthritis in patients. In the senior patient with a protrusio acetabulum fracture, a treatment strategy that optimizes preoperative conditions, minimizes operative time and blood loss, achieves a stable concentric hip joint, and encourages immediate postoperative ambulation can result in reasonable clinical, radiographic, and functional outcomes with. The acetabulum is the socket of the ballandsocket hip joint. Protrusio acetabuli in marfans syndrome sciencedirect. Pregnancy and labour in a case of intrapelvic protrusion of the acetabulum bjog. Medial wall of acetabulum is on average 2 mm lateral of ilioischial line in a male and 1 mm medial to that line in the female. Acetabular fracture and protrusio acetabuli in an elderly.
Preoperative planning of total hip arthroplasty intechopen. The deformity may be due to trauma but in many cases it is a sign of an underlying disease such as rheumatoid arthritis, ankylosing spondylitis, rickets. Using the revised criteria, the presence of protrusio would have affected the final diagnosis. They believe it was a congenital defect that i never knew until about 2 years ago when they found it. Refers to the inward bulging of the acetabulum into the pelvis usually with resultant overcovering of the femoral head. It refers to the inward bulging of the acetabulum into the pelvis usually with resultant overcovering of the femoral head. The triradiate cartilage separates these developing bones, and the articular cartilage lines the acetabulum 10,11. I believe this patient has ra with bilateral protrusio acetabuli deformity. The cornerstone of diagnosis is anteroposterior radiography and the treatment varies by age. Radiographic assessment of protrusio acetabulum is established by finding the. Overall, patients with ap had a 30% increased risk for proximal femur and acetabulum fractures p0. Protrusio acetabuli mnemonic radiology reference article.
The distance between the acetabulum and the ilioischial line. Clinical, radiographic, and functional outcomes as assessed with the modified merle daubigne score. The characteristic feature is an intrapelvic protrusion of the acetabulum and the. The acetabular labrum is a triangular fibrocartilaginous structure that forms a horseshoeshaped attachment to the acetabular rim, which connects the acetabulum to the underlying transverse acetabular ligament figure 1a. Protrusio acetabuli the cool way of saying acetabular. As discussed in more detail elsewhere in this book, the skeleton is diffusely osteoporotic in patients with osteogenesis imperfecta, owing to defective synthesis. Protrusio acetabuli is defined as an intrapelvic protrusion of the acetabulum, with a subsequent medial drift of the femoral head into the lesser pelvis. Protrusio fractures of the acetabulum in patients 70 years and older. Protrusio acetabuli is divided into two types, primary and secondary. Sep 01, 2009 in a study of 19 revision thas performed for acetabular protrusio deformity, average preoperative cup position was 10. Some people get protrusios from ordinary osteoarthritis which is neither hereditary or familial. On pelvis xrays it is seen as the acetabular fossa being medial to the ilioischial line.
If the medial wall of the acetabulum protruded medial to the ilioischial line kohlers line by 3 mm in males or 6 mm in females it favours the diagnosis of protrusio. For the skeletally immature youth, a fusion of the. Result of remodelling of weak, medial acetabular bone after multiple, recurring stress fractures. The transmission of weightbearing loads from the lower extremity to the spine is via the anterior and posterior limbs of the y, known as the anterior and. Mnemonics for remembering the causes of protrusio acetabuli include. Acetabular protrusio also known as acetabular protrusion is intrapelvic displacement of the acetabulum and femoral head, so that the femoral head projects. Acetabular fracturesacetabular fractures evaluation, anatomy and classificationevaluation, anatomy and classification muhammad abdelghani 2. This deformity results from excessive stresses upon the medial cortical bone of the acetabulum. Although simplicity is suggested in its most basic understanding as a containing device for the femoral head, the acetabulum in reality is a complex and elegantly designed structure. Figure 2 a, radiograph showing the typical appearances of primary protrusio acetabuli in a 19yearold caucasian female. In the senior patient with a protrusio acetabulum fracture variant, a treatment strategy that optimizes preoperative conditions, minimizes or time and ebl, and achieves a stable and concentric hip using an infrapectineal buttress. The acetabulum is the socket that receives the femoral head to make the hip joint. Treatment of protrusio fractures of the acetabulum in. Medialisation of the medial wall of the acetabulum with a centreedge angle 40 on an ap xr of the pelvis.
Axial ct images with 3 mm slice thickness were obtained in the study population with a ge prospeed sx ct system general. Oct 10, 2010 primary protrusio acetabulum is common in females, bilaterally, and in adolescents. Protrusio acetabuli joint replacement patient forum. The protrusio acetabulum is caused by a primary idiopathic disorder and secondary infectious, metabolic, inflammatory, traumatic, neoplastic and genetic disorders. R the devices give mechanical support to the cup 16. There is unilateral left hip process consisting of fissure in the articular cartlidge of the acetabulum. Diagnosis of protrusio is established, if the medial wall of the acetabulum is 3 mm or more medial to the ilioischial line in men or 6 mm medial. Protrusio acetabuli arthrokatadysis, otto pelvis has been defined as an affection of the hip joint characterized anatomically by deepening of the acetabulum with mesial displacement of the inner wall 1. Protrusio acetabuli in rheumatoid arthritis radiology. Protrusio acetabuli is the migration of the femoral head along the femoral neck axis, medially and. This process is experimental and the keywords may be updated as the learning algorithm improves. Note the marked protrusio and the preservation of the joint space. Protrusio fractures of the acetabulum in patients 70 years. It is suggested in the light of these findings that juvenile beaking is a true protrusion of the acetabulum, resulting from normal shear and rotation stresses without any associated bone disease.
The articular surface of the acetabulum is in the shape of an inverted horseshoe outlined in red. Introduction protrusio acetabuli pa is a wellrecognized complication in both adult 1 and juvenile rheumatoid arthritis 24. There is severe acetabular protrusio of the right hip white arrow. Protrusio fractures of the acetabulum in patients 70 years and older protrusio fractures of the acetabulum in patients 70 years and older. Understanding clinical radiology of fracture acetabulum. Protrusio acetabuli another way of saying acetabular protrusion. Evaluation of the measurement methods for protrusio acetabuli in normal children. Only then can this complex injury to a complex region be understood. The femoral head should not extend medial to a line drawn from the lateral aspect of the pelvis and the lateral aspect of the obturator foramen blue line.
Intrapelvic displacement of the medial acetabular wall. Acetabulum definition of acetabulum by medical dictionary. The deformity may be due to trauma but in many cases it is a sign of an underlying disease such as rheumatoid arthritis, ankylosing spondylitis, rickets, pagets disease and osteogenesis imperfecta. Learningradiology acetabular, protrusio, acetabuli.
This principle considers the hemipelvis to be an inverted y with a c shaped acetabular articular surface positioned between the limbs of the y. An international journal of obstetrics and gynaecology, vol. Enchondral ossification commences with formation of primary ossification centers within the ilium, ischium, and pubis between 9 and 20 weeks gestation 8,9. Protrusio acetabuli is a distortion of the hip where the acetabulum and femoral head migrate into the pelvic cavity.