Table 6.
Selected literature on treatment of hips with protrusion
| Author | Year | Treatment | Number of hips (number of patients) | Followup (years) | Results |
|---|---|---|---|---|---|
| Smith-Petersen [35] | 1936 | Open acetabuloplasty | 1 (1) | 0.8 | Case report of a 55-year-old woman with hip protrusio who underwent acebuloplasty resulting in decreased pain and improved ROM at a short-term followup |
| Viernstein et al. [49] | 1970 | Valgus and medializing intertrochanteric osteotomy, tenotomy of hip muscles | 14 (9) with osteotomy 20 (12) with tenotomy |
NA | Decreased pain and improved ROM in the majority of hips after valgus and medializing intertrochanteric osteotomy; best result in young patients (< 35 years) with limited osteoarthrosis; the technique with hip muscle release to reduce muscular tension on the joint was abandoned as a result of poor results |
| Hooper and Jones [12] | 1971 | Femoral osteotomy, acetabuloplasty, drilling, fusion of the hip, Girdlestone, hip replacement | NA (59) | NA | A series of 59 hips with conservative treatment in 36 hips and operative treatment in 23 hips; in older patients with protrusion, the THA revealed the best results regarding pain and function; no statement regarding operative treatment of younger patients was formulated |
| Rosemeyer et al. [29] | 1973 | Valgus and medializing intertrochanteric osteotomy | 25 (15) | 1–6 | Followup study of the intertrochanteric osteotomy according to Viernstein et al [43]; the valgus and medializing intertrochanteric osteotomy resulted in decreased pain and improved ROM; the best results were found in the patient group with an average age of 35 years; in patients aged 60 years and older, the benefit was only little |
| Verburg and Elzenga [48] | 1978 | Valgus intertrochanteric osteotomy | 8 (6) | 3 (mean) | The goal of surgery was a more cranial resultant force to reduce the pressure toward the floor of the acetabulum; after surgery, hip function was increased, pain decreased, and walking was increased and unlimited in 4 of 6 hips; best results were found in hips without osteoarthritic changes |
| Steel [37] | 1996 | Closure of the triradiate physis | 21 (11) | NA (until skeletal maturity) | Marfan syndrome is associated with hip protrusio; a technique for closure of the triradiate physis is presented to treat hips in patients with Marfan syndrome; performed in children up to the age of 10 years, this procedure has the potential to stop or reverse hip protrusio and symptoms relieved; in older patients, symptoms can still be relieved but radiographic improvement is unlikely |
| McBride et al. [21] | 2001 | Valgus intertrochanteric osteotomy | 19 (12) | 2–33 | Series of protrusio hips that underwent valgus intertrochanteric osteotomy with an additional closure of the triradiate physis in one skeletally immature hip; valgus intertrochanteric osteotomy should not be performed in patients aged older than age 40 years or hips with degenerative changes; in addition, preoperative limited ROM was associated with an unsatisfactory result; THA after intertrochanteric osteotomy showed no inferior results compared with primary THA |
| Leunig et al. [17] | 2009 | Acetabular rim trimming, valgus intertrochanteric osteotomy and reversed PAO | 22 (12) | 1–7 | A more tailored surgical treatment of protrusio hips is recommended; surgical hip dislocation with trimming of the acetabular rim with an optional valgus intertrochanteric osteotomy is the treatment of choice; in hips with extension of the acetabular fossa in the weightbearing zone, a reversed PAO is indicated |
| Matsuda [20] | 2012 | Hip arthroscopy | 2 (1) | 1/2 | Case report of a patient with bilateral hip protrusio and arthroscopic treatment; both hips were treated with acetabuloplasty, femoroplasty, and labral refixation in one hip and labral reconstruction gracilis autograft in the other hip; in short-term followup, both hips showed decreased pain and improved function |
| Safran and Epstein [30] | 2013 | Hip arthroscopy | 4 (3) | 2.5 | Protrusio hips treated with arthroscopic acetabuloplasty and partial labrectomy; all hips showed improved function and decreased pain |
| Liechti et al. [18] | 2015 | Periacetabular osteotomy and rim trimming | NA | NA | Finite element study evaluating stress patterns in hips with protrusio, which show 54% increased stress on the medial acetabulum compared with normal; acetabular rim trimming resulted in a further increase of 28% medial acetabular stress compared with protrusio; in contrast, periacetabular osteotomy resulted in a reduction of 25% |
NA = not applicable; PAO = periacetabular osteotomy.