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Protrusio Acetabuli: Diagnosis and Treatment

Dr. McBride is Resident Physician, Naval Medical Center San Diego, San Diego, Calif. Dr. Muldoon is Staff Physician, Naval Medical Center San Diego. Dr. Santore is Clinical Chairman, University of California, San Diego; and Chief Orthopaedic Surgeon, Sharp Memorial Hospital, San Diego. Dr. Trousdale is Consultant, Department of Orthopedics, Mayo Clinic, Rochester, Minn. Dr. Wenger is Clinical Professor of Orthopaedic Surgery, University of California, San Diego.

Reprint requests: Dr. Muldoon, Clinical Investigation Department, Medical Editing Division, Naval Medical Center San Diego, Suite 5, 34800 Bob Wilson Drive, San Diego, CA 92134-1005.

Idiopathic protrusio acetabuli is an uncommon disease process with both primary idiopathic and secondary forms. It is important to consider all etiologic possibilities before evaluating treatment options. Diagnosis is made on the basis of an anteroposterior radiograph of the pelvis that demonstrates a center-edge angle greater than 40 degrees and medialization of the medial wall of the acetabulum past the ilioischial line. For the skeletally immature patient, triradiate fusion (occasionally combined with intertrochanteric osteotomy) provides good results. For the young adult, valgus intertrochanteric proximal femoral osteotomy is recommended. In the older adult, this procedure may provide an acceptable result if there is minimal arthritis. For patients with more advanced arthritis, total hip arthroplasty with lateralization of the cup to a normal position provides a predictable long-term solution.

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