SlideShare a Scribd company logo
1 of 17
Download to read offline
Dr.Ghazwan A. Hasan
5th year Arab Board Trainee
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.
• 1st 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.
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).
DIAGNOSIS
 Clinical:
 Radiological:
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.
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.
TREATMENT
• Adolescent or Young Adult Patients: VITO by Pauwels
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.
•
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.
TREATMENT
• Ring Hip Prosthesis.
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.
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.
Protrusio acetabuli
Protrusio acetabuli
Protrusio acetabuli
POST OPERATIVE
Protrusio acetabuli

More Related Content

What's hot

Masquelet technique for management of large bone defects.
Masquelet technique for management of large bone defects.Masquelet technique for management of large bone defects.
Masquelet technique for management of large bone defects.Kushi Rithvic
 
Femoral notching in total knee arthroplasty
Femoral notching in total knee arthroplastyFemoral notching in total knee arthroplasty
Femoral notching in total knee arthroplastyIhab El-Desouky
 
Poller or blocking screw
Poller or blocking screwPoller or blocking screw
Poller or blocking screwAvik Sarkar
 
Patella dislocation by DR.NAVEEN RATHOR
Patella dislocation by DR.NAVEEN RATHORPatella dislocation by DR.NAVEEN RATHOR
Patella dislocation by DR.NAVEEN RATHORDR.Naveen Rathor
 
Surgical approaches to hip joint
Surgical approaches to hip jointSurgical approaches to hip joint
Surgical approaches to hip jointadityachakri
 
Cubitus varus by Dhrumil Patel
Cubitus varus by Dhrumil PatelCubitus varus by Dhrumil Patel
Cubitus varus by Dhrumil Pateldhrumil88
 
High Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVHigh Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVUtsav Agrawal
 
Modified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesModified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesPonnilavan Ponz
 
Principles of deformity correction
Principles of deformity correctionPrinciples of deformity correction
Principles of deformity correctionAbdulla Kamal
 
Perilunate dislocations
Perilunate dislocationsPerilunate dislocations
Perilunate dislocationsRashik Ismail
 
High tibial osteotomy
High tibial osteotomyHigh tibial osteotomy
High tibial osteotomyorthoprince
 
Templating X-rays in THR
Templating X-rays in THR Templating X-rays in THR
Templating X-rays in THR Dr. Bushu Harna
 
Acl graft fixation options
Acl graft fixation optionsAcl graft fixation options
Acl graft fixation optionsorthoprinciples
 

What's hot (20)

Masquelet technique for management of large bone defects.
Masquelet technique for management of large bone defects.Masquelet technique for management of large bone defects.
Masquelet technique for management of large bone defects.
 
Titanium elastic nail
Titanium elastic nailTitanium elastic nail
Titanium elastic nail
 
Femoral notching in total knee arthroplasty
Femoral notching in total knee arthroplastyFemoral notching in total knee arthroplasty
Femoral notching in total knee arthroplasty
 
Poller or blocking screw
Poller or blocking screwPoller or blocking screw
Poller or blocking screw
 
Patella dislocation by DR.NAVEEN RATHOR
Patella dislocation by DR.NAVEEN RATHORPatella dislocation by DR.NAVEEN RATHOR
Patella dislocation by DR.NAVEEN RATHOR
 
Dynamic hip screw
Dynamic hip screwDynamic hip screw
Dynamic hip screw
 
Surgical approaches to hip joint
Surgical approaches to hip jointSurgical approaches to hip joint
Surgical approaches to hip joint
 
Cubitus varus by Dhrumil Patel
Cubitus varus by Dhrumil PatelCubitus varus by Dhrumil Patel
Cubitus varus by Dhrumil Patel
 
High Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVHigh Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAV
 
Ankle arthrodesis
Ankle arthrodesisAnkle arthrodesis
Ankle arthrodesis
 
Acetabular defects
Acetabular defectsAcetabular defects
Acetabular defects
 
Modified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fracturesModified sauve kapandji procedure for patients with old fractures
Modified sauve kapandji procedure for patients with old fractures
 
Principles of deformity correction
Principles of deformity correctionPrinciples of deformity correction
Principles of deformity correction
 
Perilunate dislocations
Perilunate dislocationsPerilunate dislocations
Perilunate dislocations
 
Congenital pseudoarthrosis tibia
Congenital pseudoarthrosis tibiaCongenital pseudoarthrosis tibia
Congenital pseudoarthrosis tibia
 
High tibial osteotomy
High tibial osteotomyHigh tibial osteotomy
High tibial osteotomy
 
Templating X-rays in THR
Templating X-rays in THR Templating X-rays in THR
Templating X-rays in THR
 
Floating Knee
Floating KneeFloating Knee
Floating Knee
 
Acl graft fixation options
Acl graft fixation optionsAcl graft fixation options
Acl graft fixation options
 
Ottopelvis
OttopelvisOttopelvis
Ottopelvis
 

Viewers also liked

Developmental Dysplasia of the Hip and Ultrasound
Developmental Dysplasia of the Hip and UltrasoundDevelopmental Dysplasia of the Hip and Ultrasound
Developmental Dysplasia of the Hip and Ultrasoundhungnguyenthien
 
Total hip replacement in protrusio acetabuli
Total hip replacement in protrusio acetabuliTotal hip replacement in protrusio acetabuli
Total hip replacement in protrusio acetabuliAlampallam Venkatachalam
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvisberbets
 
Diatesis Pubic Symphysis - Case Presentation
Diatesis Pubic Symphysis - Case PresentationDiatesis Pubic Symphysis - Case Presentation
Diatesis Pubic Symphysis - Case PresentationAkeem Bakare
 
Developmental Dysplasia of Hip
Developmental Dysplasia of HipDevelopmental Dysplasia of Hip
Developmental Dysplasia of HipDaniel Augustine
 
Bursare In Lower Extrimity
Bursare In Lower ExtrimityBursare In Lower Extrimity
Bursare In Lower ExtrimityApeksha Besekar
 
Sporting Hip and Groin
Sporting Hip and Groin Sporting Hip and Groin
Sporting Hip and Groin Tony Tompos
 
Congenital hip dislocation
Congenital hip dislocationCongenital hip dislocation
Congenital hip dislocationareejalo92
 
Contracted pelvis (diagnosis and treatment)
Contracted pelvis (diagnosis and treatment)Contracted pelvis (diagnosis and treatment)
Contracted pelvis (diagnosis and treatment)fidaey48
 
Pubic Diastasis Power Point
Pubic Diastasis Power PointPubic Diastasis Power Point
Pubic Diastasis Power PointTodd Peterson
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvisraj kumar
 
Hip dysplesia ppt
Hip dysplesia pptHip dysplesia ppt
Hip dysplesia pptRMLIMS
 
Teratoma sacrococcígeo
Teratoma sacrococcígeoTeratoma sacrococcígeo
Teratoma sacrococcígeoFabian Hoyos
 
Teratoma
TeratomaTeratoma
Teratomamo mo
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvisdrmcbansal
 

Viewers also liked (20)

Developmental Dysplasia of the Hip and Ultrasound
Developmental Dysplasia of the Hip and UltrasoundDevelopmental Dysplasia of the Hip and Ultrasound
Developmental Dysplasia of the Hip and Ultrasound
 
Total hip replacement in protrusio acetabuli
Total hip replacement in protrusio acetabuliTotal hip replacement in protrusio acetabuli
Total hip replacement in protrusio acetabuli
 
DDH
DDHDDH
DDH
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvis
 
Diatesis Pubic Symphysis - Case Presentation
Diatesis Pubic Symphysis - Case PresentationDiatesis Pubic Symphysis - Case Presentation
Diatesis Pubic Symphysis - Case Presentation
 
Developmental Dysplasia of Hip
Developmental Dysplasia of HipDevelopmental Dysplasia of Hip
Developmental Dysplasia of Hip
 
Bursare In Lower Extrimity
Bursare In Lower ExtrimityBursare In Lower Extrimity
Bursare In Lower Extrimity
 
Ddh 1
Ddh 1Ddh 1
Ddh 1
 
Sporting Hip and Groin
Sporting Hip and Groin Sporting Hip and Groin
Sporting Hip and Groin
 
Peurperium
PeurperiumPeurperium
Peurperium
 
Congenital hip dislocation
Congenital hip dislocationCongenital hip dislocation
Congenital hip dislocation
 
Contracted pelvis (diagnosis and treatment)
Contracted pelvis (diagnosis and treatment)Contracted pelvis (diagnosis and treatment)
Contracted pelvis (diagnosis and treatment)
 
Pubic Diastasis Power Point
Pubic Diastasis Power PointPubic Diastasis Power Point
Pubic Diastasis Power Point
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvis
 
DDH
DDHDDH
DDH
 
Hip dysplesia ppt
Hip dysplesia pptHip dysplesia ppt
Hip dysplesia ppt
 
Teratoma sacrococcígeo
Teratoma sacrococcígeoTeratoma sacrococcígeo
Teratoma sacrococcígeo
 
Teratoma
TeratomaTeratoma
Teratoma
 
Hip joint anatomy
Hip joint anatomyHip joint anatomy
Hip joint anatomy
 
Contracted pelvis
Contracted pelvisContracted pelvis
Contracted pelvis
 

Similar to Protrusio acetabuli

High Tibial Osteotomies
High Tibial OsteotomiesHigh Tibial Osteotomies
High Tibial OsteotomiesGhazwan Bayaty
 
Lumbar Hernia through an Iliac Crest Bone Graft Defect
Lumbar Hernia through an Iliac Crest Bone Graft DefectLumbar Hernia through an Iliac Crest Bone Graft Defect
Lumbar Hernia through an Iliac Crest Bone Graft Defectasclepiuspdfs
 
Patella in total knee arthroplasty to resurface or not is the question
Patella in total knee arthroplasty  to resurface or not is the  questionPatella in total knee arthroplasty  to resurface or not is the  question
Patella in total knee arthroplasty to resurface or not is the questionBipulBorthakur
 
Avascular necrosis of femoral head 1456920705296
Avascular necrosis of femoral head 1456920705296Avascular necrosis of femoral head 1456920705296
Avascular necrosis of femoral head 1456920705296Gaurav Singh
 
L01_Hip-dislocatinos-femoral-head.ppt
L01_Hip-dislocatinos-femoral-head.pptL01_Hip-dislocatinos-femoral-head.ppt
L01_Hip-dislocatinos-femoral-head.ppttoto798365
 
Posterior Spine Fixation
Posterior Spine FixationPosterior Spine Fixation
Posterior Spine FixationGhazwan Bayaty
 
Complications of total hip replacement final
Complications of total hip replacement finalComplications of total hip replacement final
Complications of total hip replacement finalHumayun Israr
 
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERY
ANESTHETIC MANAGEMENT  OF TOTAL HIP REPLACEMENT SURGERYANESTHETIC MANAGEMENT  OF TOTAL HIP REPLACEMENT SURGERY
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERYDebashish Mondal
 
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
 
Maxillary Osteotomy Procedures
Maxillary Osteotomy ProceduresMaxillary Osteotomy Procedures
Maxillary Osteotomy Proceduresdr.nikil נαιη
 
Maxillary orthognathic surgery
Maxillary orthognathic surgeryMaxillary orthognathic surgery
Maxillary orthognathic surgerydrmohitmangla
 
Soft Tissue Injuries Of The Ankle
Soft Tissue Injuries Of The Ankle Soft Tissue Injuries Of The Ankle
Soft Tissue Injuries Of The Ankle Verma25
 
surgical treatment of Associated patterns fracture acetabulum
 surgical treatment of Associated  patterns fracture acetabulum surgical treatment of Associated  patterns fracture acetabulum
surgical treatment of Associated patterns fracture acetabulumSherif El Aidy
 
Orbital floor blow out fractures
Orbital floor blow out fracturesOrbital floor blow out fractures
Orbital floor blow out fracturesAhmed Adawy
 
British Columbia Medical Journal - November 2010: Knee Arthroplasty
British Columbia Medical Journal - November 2010: Knee ArthroplastyBritish Columbia Medical Journal - November 2010: Knee Arthroplasty
British Columbia Medical Journal - November 2010: Knee ArthroplastyBritish Columbia Medical Journal
 

Similar to Protrusio acetabuli (20)

High Tibial Osteotomies
High Tibial OsteotomiesHigh Tibial Osteotomies
High Tibial Osteotomies
 
Lumbar Hernia through an Iliac Crest Bone Graft Defect
Lumbar Hernia through an Iliac Crest Bone Graft DefectLumbar Hernia through an Iliac Crest Bone Graft Defect
Lumbar Hernia through an Iliac Crest Bone Graft Defect
 
Patella in total knee arthroplasty to resurface or not is the question
Patella in total knee arthroplasty  to resurface or not is the  questionPatella in total knee arthroplasty  to resurface or not is the  question
Patella in total knee arthroplasty to resurface or not is the question
 
Avascular necrosis of femoral head 1456920705296
Avascular necrosis of femoral head 1456920705296Avascular necrosis of femoral head 1456920705296
Avascular necrosis of femoral head 1456920705296
 
arthrodesis
 arthrodesis arthrodesis
arthrodesis
 
L01_Hip-dislocatinos-femoral-head.ppt
L01_Hip-dislocatinos-femoral-head.pptL01_Hip-dislocatinos-femoral-head.ppt
L01_Hip-dislocatinos-femoral-head.ppt
 
Posterior Spine Fixation
Posterior Spine FixationPosterior Spine Fixation
Posterior Spine Fixation
 
Lefort 1 osteotomy
Lefort 1 osteotomyLefort 1 osteotomy
Lefort 1 osteotomy
 
Complications of total hip replacement final
Complications of total hip replacement finalComplications of total hip replacement final
Complications of total hip replacement final
 
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERY
ANESTHETIC MANAGEMENT  OF TOTAL HIP REPLACEMENT SURGERYANESTHETIC MANAGEMENT  OF TOTAL HIP REPLACEMENT SURGERY
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERY
 
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...
 
Maxillary Osteotomy Procedures
Maxillary Osteotomy ProceduresMaxillary Osteotomy Procedures
Maxillary Osteotomy Procedures
 
Maxillary orthognathic surgery
Maxillary orthognathic surgeryMaxillary orthognathic surgery
Maxillary orthognathic surgery
 
Soft Tissue Injuries Of The Ankle
Soft Tissue Injuries Of The Ankle Soft Tissue Injuries Of The Ankle
Soft Tissue Injuries Of The Ankle
 
Primary Pelvic Hydatid Cyst.pdf
Primary Pelvic Hydatid Cyst.pdfPrimary Pelvic Hydatid Cyst.pdf
Primary Pelvic Hydatid Cyst.pdf
 
ventral hernias
ventral herniasventral hernias
ventral hernias
 
surgical treatment of Associated patterns fracture acetabulum
 surgical treatment of Associated  patterns fracture acetabulum surgical treatment of Associated  patterns fracture acetabulum
surgical treatment of Associated patterns fracture acetabulum
 
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdfFemoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
 
Orbital floor blow out fractures
Orbital floor blow out fracturesOrbital floor blow out fractures
Orbital floor blow out fractures
 
British Columbia Medical Journal - November 2010: Knee Arthroplasty
British Columbia Medical Journal - November 2010: Knee ArthroplastyBritish Columbia Medical Journal - November 2010: Knee Arthroplasty
British Columbia Medical Journal - November 2010: Knee Arthroplasty
 

Recently uploaded

Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 

Recently uploaded (20)

Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 

Protrusio acetabuli

  • 1. Dr.Ghazwan A. Hasan 5th 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. • 1st 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).
  • 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.