''Protrusio acetabuli'' is an uncommon defect of the ''

acetabulum The acetabulum (; : acetabula), also called the cotyloid cavity, is a wikt:concave, concave surface of the pelvis. The femur head, head of the femur meets with the pelvis at the acetabulum, forming the Hip#Articulation, hip joint. Structure The ...

'', the socket that receives the

femoral head The femoral head (femur head or head of the femur) is the highest part of the thigh bone (femur The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the ...

to make the hip joint. The

hip bone The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the Ilium (bone) ...

of the

pelvic bone The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the ilium, isch ...

/girdle is composed of three

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

s, the ilium, the

ischium The ischium (; : is ...

and the pubis. In protrusio deformity, there is medial displacement of the femoral head in that the medial aspect of the femoral cortex is medial to the ilioischial line. The socket is too deep and may protrude into the

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

Signs and symptoms

''Protrusio acetabuli'' may be

asymptomatic Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test). P ...

. Limitation of joint range of movement is the earliest sign, along with pain.

Classification

''Protrusio acetabuli'' is divided into two types, primary and secondary. * Primary ''protrusio acetabuli'' are characterized by progressive ''protrusio'' in middle aged women, and may be associated with

osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

. They may be familial. * Secondary ''protrusio acetabulis causes include femoral head

prosthesis In medicine, a prosthesis (: prostheses; from ), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through physical trauma, disease, or a condition present at birth (Congenital, congenital disord ...

, cup

arthroplasty Arthroplasty (literally " e-orming of joint") is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that ...

septic arthritis Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typica ...

, central fracture dislocation, or

total hip replacement Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacem ...

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

''Protrusio acetabuli'' may also be thought of as unilateral or bilateral. * Unilateral ''protrusio acetabuli'' may be caused by tuberculous arthritis, trauma, or

fibrous dysplasia Fibrous dysplasia is a very rare nonhereditary genetic disorder where normal bone and marrow is replaced with fibrous tissue, resulting in formation of bone that is weak and prone to expansion. As a result, most complications result from fract ...

. * Bilateral ''protrusio acetabuli'' may be caused by

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

, Paget's disease,

osteomalacia Osteomalacia is a disease characterized by the softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The impairment of b ...

,Dahnert's Radiology

Marfan syndrome Marfan syndrome (MFS) is a multi-systemic genetic disorder that affects the connective tissue. Those with the condition tend to be tall and thin, with dolichostenomelia, long arms, legs, Arachnodactyly, fingers, and toes. They also typically ha ...

, and ankylosing spondylitis.

Prognosis

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

Treatment

Arthroscopic surgery (or open joint surgery) is an effective treatment. Joint replacement surgery may be necessary in the case of severe pain or substantial joint restriction.

References

External links

* {{Authority control Arthritis Pelvis Arthropathies