Table 2.
Study Characteristics and Demographic Details
| Study | Country | Inclusion/exclusion criteria | Etiology | Total hips | Study design | Mean age (yr) | Sex (F:M) | Extension of protrucio from Kohler’s line/Sotelo-Garza classification | Intervention | Approach | Implant | Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zhen et al.3) (2018) | China | Protrusio in RA | RA | 20 hips (18 patients) | Prospective cohort | 45.8±8.3 | 12:6 | 12.7 mm | Uncemented with bone grafting | Posterolateral approach | Porous tantalum cups, 16 hips; titanium porous coated cups, 4; 4th generation ceramic-ceramic implantations, 8; polyethylene-lined ceramic implantations, 12 | 4.5±1.7 yr |
| Baghdadi et al.8) (2015) | USA | THA done in protrusio | OA, 48 hips; RA, 15; sequele of septic arthritis, 2 | 65 hips (53 patients) | Retrospective cohort | 66 | 53:12 | 7±4 mm | Uncemented 58 hips, impacted with morselized bone graft; 26 hips, supplementary screw fixation |
Anterolateral, 34 procedures; posterior, 28; transtrochanteric, 3 | Harris-Galante (HG)-I, 6 hips; Harris-Galante (HG)-II, 13; Omnifit, 17; Reflection™, 7; Porous-Coated Anatomic (PCA), 4; Press-Fit Condylar (PFC), 2; Elliptical, 1; Bi-Articular, 1; Trilogy®, 11; Hedrocel®, 3 | 15.4 yr |
| Dutka et al.10) (2011) | Poland | 1. THA done in patients with protrusion acetabuli with any etiology 2. Minimum 4-year follow-up 3. Full medical records available |
RA, 122 hips; Otto’s disease, 6; psoriatic arthritis, 3; SLE, 2; acetabular fracture, 1; radiation damage, 1 | 135 hips (127 patients) | Retrospective cohort | 55.2 | 119:8 | Grade 1, 48; grade 2, 36; grade 3, 21 | 128 hips, cemented; 7 hips, uncemented Autogenous grafts, 97 hips; mixed grafts, 38 |
NA | NA | 12.7 yr |
| Mullaji et al.20) (2007) | India | 1. Primary THAs in significant protrusio acetabuli 2. Minimum follow-up of 2 years |
RA, 14 patients; ankylosing spondylitis, 5; Idiopathic, 4 | 30 hips (23 patients) | Prospective cohort | 46 | 17:6 | Grade 1, 8; grade 2, 10; grade 3, 12 | Uncemented THR with morselized BG | Anterolateral approach | Duraloc porous-coated cups, 17 cases; Bicontact cups, 13 One screw used to augment, 15 cases; 2 screws used, 12; no screw used, 3 A porous-coated stem used 21 cases: Bicontact, 13; Summit, 8 Cemented Charnley stems used, 9 cases |
4.2 yr |
| Krushell et al.15) (2008) | England | Primary THA of any cause with acetabular protrusio | Inflammatory arthritis in 22 cases and OA in 7 cases | 29 hips (27 patients) | Retrospective cohort | 66 | 20:7 | Mean, 4.1 mm protrucio medial to Kohler’s line | Uncemented, Autologous BG in all cases Additional synthetic grafts, 3 cases |
Posterolateral approach | Beaded dual-geometry acetabular shell design with multilayer titanium MicroStructured porous ingrowth surface | 4 yr |
| Baghdadi et al.2) (2013) | USA | All patients with protrusio acetabuli who had undergone primary THR with a minimum follow-up of 2 years | Idiopathic, 117 hips; underlying inflammatory component, 38; genetic - 2, post infectious - 2, post radiation - 1, metabolic - 2 | 162 hips (127 patients) | Retrospective cohort | 66±13 | 112:15 | 7±5 mm | Cemented, 55 hips (14/55 cemented hips, bone grafting) Uncemented, 107 hips (83/107 uncemented hips, bone grafting done) |
First-generation designs: Charnley, Aufranc Turner, Elliptical, Ti-Bac Cups Second-generation designs: Harris-Galante (HG)-I, Harris-Galante (HG)-II, Omnifit, Reflection, Porous-Coated Anatomic, PressFit Condylar Third-generation designs: Pinnacle, Trilogy, Hedrocel, Trident, Trabecular Metal Modular, Tritanium Hemispherical Cluster |
10±6 yr | |
| Hansen and Ries12) (2006) | USA | 1. Revision surgeries 2. Large medial defect with at least 50% radiographic projected acetabular bone loss 3. Minimum 2-year follow-up |
OA in 9 patients, RA in 3, posttraumatic arthritis in 2, avascular necrosis in 1, PVNS in 1, and DDH in 1 | 19 hips (17 patients) | Prospective cohort | 66 | 13:9 | 10.5 mm | Uncemented porous coated acetabular cup and morselized allograft | Posterior approach+ extended trochanteric osteotomy if necessary | Cementless hemispherical component with a widened peripheral rim | 2.8 yr |
| Rosenberg et al.21) (2000) | Netherlands | 1. Patients diagnosed as RA with protrusio hip who under goes THA 2. Patients with minimum 8-year follow-up |
RA | 20 hips (16 patients) | Prospective cohort | 53 | 13:3 | NA | Cemented cups with Morselized allograft | Posterolateral approach | 32 mm polyethylene Mueller or Allopro cup | 11.7 yr |
| Matsuno et al.18) (2000) | Japan | Patients diagnosed to have RA with protrusio hip | RA | 15 hips (13 patients) | Prospective cohort | 61.9 | 9:4 | NA | Uncemented with iliac crest and morsellised femoral head graft | Aposterior approach | MC cup supporter | 53.6 mo |
| Gates et al.11) (1989) | USA | Painful progressive protrusio acetabuli | RA, hemiarthroplasty, THA, OA | 48 hips (40 patients) | Prospective cohort | 57.8 | 29:11 | 8.6 mm | Cemented THA with medial acetabular reinforcement with BG Autologous BG, 39 hips; Allograft, 9 | NA | NA | 12.3 yr |
| Kondo et al.14) (2002) | Japan | RA with protrusion acetabuli treated with THA Minimum 9-year follow-up |
RA | 25 hips (19 patients) | Prospective cohort | 56.7 | 16:3 | Grade 1, 8; grade 2, 13; grade 3, 4 | Cemented with autologous graft | NA | NA | 129.6 mo |
| Liu et al.17) (2023) | China | 1. RA 2. Moderate and severe in patients with acetabular protrusions in which the bottom of the acetabulum exceeded Kohler’s line in the pelvic AP radiography |
RA | 56 hips (45 patients) | Prospective cohort | 55.64±5.38 | 28:17 | 10.97±3.08 mm | Uncemented THA with impacted bone grafting | Posterolateral approach | Biological total hip prostheses: A porous tantalum cup, 42 hips; sintered, three-dimensional, asymmetric, titanium, and porous-coated cups, 14; weight-bearing interfaces, 24; fourth-generation ceramic-on-ceramic implantations, and ceramic-on-highly cross-linked polyethylene, 32 | 5.20±1.20 yr |
| Zuh et al.23) (2015) | Romania | THA in protrusio | Protrusion of unknown aetiology, 16 hips; RA, 6; protrusion secondary to tuberculous arthritis, 3; post-traumatic protrusion, 2; hip arthritis with thin medial acetabular wall, 12 | 39 hips (32 patients) | Retrospective study | 58.3±8.9 | 15:17 | I, 15 hips; II, 9; III, 3; thin medial wall, 12 | Medial acetabular wall – augmented by impaction bone grafting Uncemented cup – all cases |
Direct lateral approach | 4.5 yr | |
| Yun et al.22) (2021) | USA | THA in protrusio | 5 patients, RA; 18 patients, idiopathic PA | 23 THAs in 21 patients | Retrospective study | 68±9 | 19:2 | Mild, 7 patients; moderate, 13; severe, 3 | Morcellized femoral head autograft using Bone Mill, cementless acetabular cups | Direct anterior approach | 5.3 yr | |
| Mibe et al.19) (2005) | Japan | Protrusio in RA | RA | 19 hips of 15 patients | Retrospective | 60.2 (48-75) | All F | 12 hips, grade 1; 3 hips, grade 2; 1 hip, grade 3 Medial-proximal type, 3 hips |
THA using a support ring All cups- cemented |
Not mentioned | 4 hips, TACT cup supporter; 1 hip, Kerboull plate; 6 hips, a Ganz ring; 5 hips, Müller ring | 38 mo |
| Lee et al.16) (2022) | Korea | THA in protrusio | RA, 14 hips; post-traumatic arthritis, 7; ankylosing spondylitis, 4; previous infection, 1 | 26 cementless THAs of 22 patients | Retrospective study | 59.9 | 17:5 | Mild, 5 hips; moderate, 19; severe, 2 | Uncemented THA, reinforcement acetabular components in 2 hips | Kocher-Langenbeck approach | PLASMACUP SC, 9 hips; Bencox cup, 7; Pinnacle cup, 5; G7 cup, 1; ABT cup, 1; Delta TT cup, 1 SPH reinforcement cups, 2 hips with defective rim of the acetabulum |
5.1 yr |
| Figueras Coll et al.9) (2008) | Spain | THA in protrusio | Severe arthrosis (50% of cases), protrusio due to hemiarthroplasties (15%), and rheumathoid arthritis (15%) Aseptic loosening of the acetabular cup in THA, and some other causes- less common diagnoses |
25 hips (25 patients) | Retrospective study | 71.1 | 16:9 | Paproski’s classification – 20 type IIa cases, 4 type IIb and 1 type IIc | Cemented acetabular cup, autogenous morcellized bone-graft and acetabular wiremesh | Anterolateral | Charnley stem and cemented cup (7 right and 18 left hips) | 8.6 yr |
| Johnsson et al.13) (1984) | Sweden | Protrusio in RA | RA | 27 hips (25 patients) | Retrospective study | 56 (29-76) | 21:4 | Joint destruction according to Larsen and Larsen et al. 12 hips, grade IV; 15 hips, grade V Mean acetabular protrusion, 6 mm |
Spongious bone chips from the trochanter and/or the femoral head, and iliac crest, 10 cases – thin titanium net A high density polyethylene (HDPE) protrusion cup – last 5 cases |
26 hips, postero-lateral; 1 hip, anterior approach without trochanteric osteotomy | Lubinus (25) and McKee-Arden (2) types | 2 yr |
Values are presented as mean±standard deviation or mean (range).
F: female, M: male, RA: rheumatoid arthritis, THA: total hip arthroplasty, OA: osteoarthritis, SLE: systemic lupus erythematosus, NA: not available, THR: total hip replacement, BG: bone graft, PVNS: pigmented villonodular synovitis, DDH: developmental dysplasia of hip, AP: anteroposterior, PA: protrusio acetabuli.