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:
