Protrusio acetabuli

Protrusio acetabuli is an uncommon defect of the acetabulum. The acetabulum is the socket that receives the femoral head to make the hip joint. It is composed of three bones, the ilium, the ischium and the pubis. The socket is too deep and may protrude into the pelvis.



Classification
Protrusio acetabuli is divided into two types, primary and secondary.

Primary protrusio acetabuli

 * Characterized by progressive protrusio in middle aged women
 * May be associated with OA
 * May be familial

Secondary protrusio acetabuli
Causes include:

may be present bilaterally in paget's, marfan's, RA, AS, & osteomalacia;


 * Femoral head prosthesis
 * Cup arthroplasty
 * Septic arthritis
 * Central fracture dislocation
 * Total hip replacement surgery

Signs and Symptoms

 * May be asymptomatic
 * Limitation of joint range of movement is the earliest sign
 * Pain

Natural course
The protrusio may progress until the femoral neck impinges against the pelvis.

Diagnosis
Diagnosis is made on the basis of an anteroposterior radiograph of the pelvis that demonstrates a center-edge angle greater than 40 degrees and medialisation of the medial wall of the acetabulum past the ilioischial line.

Treatment
Joint replacement surgery is indicated for severe pain or substantial joint restriction