Managing Protrusio Acetabuli With a Direct Anterior Approach Total Hip Replacement

Introduction The deformities of protrusio acetabuli (PA) present unique reconstructive challenges. An incarcerated femoral head, medialized center of rotation, deficient bone stock, and associated leg length discrepancy add significant technical complexity to total hip arthroplasty (THA). Methods We retrospectively reviewed 23 THAs in 21 patients with PA who underwent direct anterior (DA) approach THA with intraoperative fluoroscopy. All acetabular defects were reconstructed with morcellized femoral head autograft using Bone Mill (Stryker Corporation, Kalamazoo, MI). Results The mean AK distance preoperatively was 8 mm (range: 1-16). Postoperatively, the degree of protrusio improved in all cases, and the mean AK distance decreased to 0 mm. All bone grafts consolidated, and no cups loosened or were revised at a mean of 5.3 years of follow-up. The mean Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) at follow-up was 91. Conclusions These data suggest that the DA approach with intraoperative fluoroscopy may be a reasonable technique in the surgical management of this challenging population.