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Impacted, morselized graft restores hip biomechanics in acetabular protrusio

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Arun B. Mullaji

ORLANDO, Fla. — Templating, bone grafting and using a rim-fitting porous cup are effective for addressing primary or secondary acetabular protrusio, a rare problem that can occur in patients with rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteomalacia or Paget’s disease, as well as in post-traumatic situations.

“Acetabular protrusio presents three challenges to the surgeon: one, the hip center is medial and proximal; bone is deficient medially; and there is reduced bony support for the socket,” Arun B. Mullaji, FRCS(Ed), MS, said at the Current Concepts in Joint Replacement Winter Meeting.

The surgical technique he presented to remedy acetabular protrusio involves templating the hip to restore hip biomechanics and the true hip center. The next step is dislocating the hip prior to bone grafting the acetabulum with 8-mm to 10-mm sized morselized graft particles, which Mullaji said, may be challenging in patients with acetabular protrusio. The graft is placed on the floor of the prepared acetabulum and then impacted, he said, noting a rim-fitting porous cup should be used. However, Mullaji noted, the technique can be used with most cups.

“Impacted, morselized graft with a porous-coated cementless socket is typically a straightforward solution. It restores biologically the deficient medial floor [and] provides some mechanical fixation, preventing the recurrence of protrusio, while templating helps to restore the biomechanics.” Mullaji said. – by Susan M. Rapp

Reference:

Mullaji A. Paper #32. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.

Disclosure: Mullaji reports he receives royalties and consulting fees for design, consulting and teaching from DePuy Synthes; he receives royalties from Springer; and he receives consulting fees for design and teaching from Zimmer Biomet.