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A lack of bone stock, deficient medial cup support and medial & proximal migration of the joint center are the main challenges in treating cases of protrusio acetabuli with end stage arthritis. The purpose of this prospective study was to assess the functional outcome, radilogical parameters & complications related to uncemented total hip arthroplasty in these patients. Material and methods: From November2017 to December 2019, 20 patients (33 hips) with secondary acetabular protrusions (25 grade II & 8 grade I) with end stage arthritis underwent uncemented total hip arthroplasties with or without autologous bone grafting. The Harris hip scoring system was used to evaluate hip function during follow-up. X-rays were taken to assess the prosthesis loosening, bone graft healing, cup inclination angle & comparing various pre and postoperative radiological parameters. Results: The operation time ranged from 60 to 120 min (mean =77.12 ± 14 min). The blood loss was 200 to 400 mL (mean = 252 ± 49.5 mL). The average follow-up duration was 1.5 years (range 6m-2yrs). Postoperative X-rays revealed bone graft union at 6 months post-surgery. The Harris hip scores increased from 34.07 ± 11.43 to 86.22 ± 6.85 postoperatively that was statistically significant (P < 0.01). The distance from the center of the femoral head to Kohler’s line increased from 18.76 ± 3.7 mm to 20.4 ± 3.3 mm after the operation (P < 0.01). During follow-up, no hip acetabular prosthesis loosening & progression of protrusio was evident.There was no dislocation but one case of infection and one case of sciatic nerve injury as postoperative complication. Conclusion: The use of impacted or unimpacted morselized autograft in conjunction with porous-coated cementless acetabular components was a technically straight forward solution through which the hip bio mechanics were restored and strong fixation was achieved, thereby preventing recurrence of protrusio in grade II or III. For grade I protrusio with end stage arthritis only uncement THR without bone graft was adequate.

Evaluation of Uncemented Total Hip Arthroplasty in Acetabular Protrusio