http://www.bjj.boneandjoint.org.uk/content/95-B/11_Supple_A/37.abstract

Acetabular protrusio

Surgical technique of dealing with a problem in depth

A. B. Mullaji, FRCS Ed, MCh Orth, MS Orth, Consultant, Joint Replacement Surgeon1; and
G. M. Shetty, MS Orth, Consultant, Arthritis Care & Joint Replacement Surgeon2

+ Author Affiliations

1Breach Candy Hospital, The Arthritis Clinic, 101 Cornelian, Kemp’s Corner, Cumballa Hill, Mumbai 400036, India.
2Asian Hospital and Indian Orthopaedic Research Group, Asian Orthopedic Institute, G/N Block, Bandra-Kurla Complex, Bandra East, Mumbai 400051, India.

Correspondence should be sent to Dr A. B. Mullaji; e-mail:arunmullaji@gmail.com

Resumen

Hay pocos informes que describen la técnica de gestión de protrusión acetabular en el reemplazo total de cadera primaria . La mayoría son pequeñas series con diferentes métodos de hacer frente a los desafíos de la medial significativa y la migración proximal de la junta central , hueso medial deficiente y reducida soporte óseo periférico al componente acetabular. Describimos nuestra técnica y el resultado clínico y radiológico de utilizar impactado autoinjerto morsellised con una taza cementado con recubrimiento poroso en 30 THR primaria con leve ( n = 8 ) grados de acetabular , moderada ( n = 10 ) y grave ( n = 12 ) protrusión . La media de puntuación de cadera de Harris había mejorado desde el 52 antes de la cirugía y 85 a una media de seguimiento de 4,2 años ( 2-10 ) . Al final del seguimiento , 27 caderas ( 90 %) tuvieron un resultado bueno o excelente , dos ( 7 %) tuvieron un resultado justo y uno ( 3 %) tuvieron un mal resultado . Todos los injertos óseos se habían unido por el sexto mes post-operatorio y ninguna de las caderas mostraron ninguna evidencia radiológica de recurrencia de protrusión , osteolisis o desprendimiento . Mediante el uso de autoinjerto impactado morsellised y componentes acetabulares no cementados que era posible lograr la restauración de la mecánica de la cadera , proporcionar una solución biológica a la deficiencia de hueso y asegurar una fijación a largo plazo sin recurrencia en las caderas artríticas con la protrusión de someterse a THR .

Abstract

There are few reports describing the technique of managing acetabular protrusio in primary total hip replacement. Most are small series with different methods of addressing the challenges of significant medial and proximal migration of the joint centre, deficient medial bone and reduced peripheral bony support to the acetabular component. We describe our technique and the clinical and radiological outcome of using impacted morsellised autograft with a porous-coated cementless cup in 30 primary THRs with mild (n = 8), moderate (n = 10) and severe (n = 12) grades of acetabular protrusio. The mean Harris hip score had improved from 52 pre-operatively to 85 at a mean follow-up of 4.2 years (2 to 10). At final follow-up, 27 hips (90%) had a good or excellent result, two (7%) had a fair result and one (3%) had a poor result. All bone grafts had united by the sixth post-operative month and none of the hips showed any radiological evidence of recurrence of protrusio, osteolysis or loosening. By using impacted morsellised autograft and cementless acetabular components it was possible to achieve restoration of hip mechanics, provide a biological solution to bone deficiency and ensure long-term fixation without recurrence in arthritic hips with protrusio undergoing THR.

Cite this article: Bone Joint J 2013;95-B, Supple A:37–40.

Footnotes

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

This paper is based on a study which was presented at the 29th Annual Winter 2012 Current Concepts in Joint Replacement® meeting held in Orlando, Florida, 12th – 15th December.

Received September 7, 2013.
Accepted September 8, 2013.