Protrusio acetabuli is a defect of the central acetabulum resulting from migration of the femoral head medial to the Ilio-ischial (Kohler's) line. There are a number of causes, the common ones being secondary to inflammatory cause and others including metabolic, post traumatic, osteogenesis imperfecta, Paget's disease.
The common factor is a metabolic or mechanical alteration of the peri-acetabular bone. Central migration occurs along the resultant joint-reaction force vector. Total hip arthroplasty has been the traditional surgical treatment and requires reconstruction of the contained central bony defect with bone graft. Lateralization of the cup is necessary to a successful outcome.
Careful pre-operative planning is required to assess limb length, implant choice, size and position. The outcome of THR with bone grafting for protrusion has been favorable with success rates comparable to primary THR.
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