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Managing Protrusio Acetabuli With a Direct Anterior Approach Total Hip Replacement.

Andrew Yun1, Marilena Qutami1, Eric Carles1

  • 1Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, USA.

Cureus
|April 26, 2021
PubMed
Summary

The direct anterior (DA) approach with intraoperative fluoroscopy effectively treats protrusio acetabuli (PA) hip deformities. This technique successfully reconstructs bone defects and improves patient outcomes, offering a viable solution for complex hip replacements.

Keywords:
bone graftdirect anterior approachfluoroscopyprotrusio acetabulitotal hip replacement

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Area of Science:

  • Orthopedic Surgery
  • Reconstructive Surgery

Background:

  • Protrusio acetabuli (PA) presents significant reconstructive challenges in total hip arthroplasty (THA).
  • Key complexities include incarcerated femoral head, medialized center of rotation, bone stock deficiency, and leg length discrepancy.

Purpose of the Study:

  • To evaluate the efficacy of the direct anterior (DA) approach with intraoperative fluoroscopy for THA in patients with PA.
  • To assess bone graft consolidation, implant stability, and functional outcomes.

Main Methods:

  • Retrospective review of 23 THAs in 21 patients with PA.
  • Utilized the direct anterior (DA) approach with intraoperative fluoroscopy.
  • Reconstructed acetabular defects using morcellized femoral head autograft.

Main Results:

  • Significant improvement in protrusio, with mean AK distance decreasing from 8 mm to 0 mm.
  • All bone grafts consolidated, with no cup loosening or revision at a mean follow-up of 5.3 years.
  • High functional outcome scores (mean HOOS, JR of 91).

Conclusions:

  • The DA approach combined with intraoperative fluoroscopy is a reasonable surgical technique for managing protrusio acetabuli.
  • This method effectively addresses the complexities of PA, leading to successful reconstruction and improved patient function.