Acetabular protrusion, also known as protrusio acetabuli, is intrapelvic displacement of the acetabulum and femoral head, so that the femoral head projects medial to the ilioischial line. It should be differentiated from coxa profunda.
Acetabular protrusion is divided into primary and secondary types.
Primary acetabular protrusion is characterized by a progressive protrusion in middle-aged women. The condition may be associated with osteoarthritis and may be familial.
- Paget disease
- psoriatic arthropathy
- rheumatoid arthritis
- ankylosing spondylitis
- osteomalacia / rickets
- osteogenesis imperfecta
- Marfan syndrome
- hemophilia (in advanced arthropathy) 5
- intrapelvic displacement of the medial wall of the acetabulum
Different diagnostic criteria have been suggested on an anteroposterior radiograph of the pelvis:
- center-edge angle greater than 40 degrees and medialisation of the medial wall of the acetabulum past the ilioischial line (Kohler's line) 3
- acetabular fossa greater than 3 mm beyond the ilioischial line in men and greater than 6 mm in women 6
- projection of the femoral head medial to the ilioischial line 7
A useful trick is that the acetabular cavity will often, but not always, be seen protruding medially to the iliopectineal line.
- 1. Kuhlman JE, Scott WW, Fishman EK et-al. Acetabular protrusion in the Marfan syndrome. Radiology. 1987;164 (2): 415-7. Radiology (abstract) - Pubmed citation
- 2. Van De Velde S, Fillman R, Yandow S. The aetiology of protrusio acetabuli. Literature review from 1824 to 2006. Acta Orthop Belg. 2007;72 (5): 524-9. Pubmed citation
- 3. McBride MT, Muldoon MP, Santore RF et-al. Protrusio acetabuli: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9 (2): 79-88. Pubmed citation
- 4. Femoroacetabular Impingement. Springer. ISBN:3642227686. Read it at Google Books - Find it at Amazon
- 5. Scharrer I, Schramm W. 34th Hemophilia Symposium Hamburg 2003. Springer Berlin Heidelberg. ISBN:B000PC6CJ6. Read it at Google Books - Find it at Amazon
- 6. Donald Resnick, Mark J. Kransdorf. Bone and Joint Imaging, 3rd edition. (2004) ISBN: 9780721602707
- 7. Anderson LA, Kapron AL, Aoki SK et-al. Coxa profunda: is the deep acetabulum overcovered?. Clin. Orthop. Relat. Res. 2012;470 (12): 3375-82. doi:10.1007/s11999-012-2509-y - Free text at pubmed - Pubmed citation