Protrusio acetabuli: contraindication or indication for hip arthroscopy? And the case for arthroscopic treatment of global pincer impingement

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Dean K Matsuda

Abstract

Protrusio acetabuli has been considered a contraindication for hip arthroscopy. We present the case of a 33-year-old man with bilateral symptomatic protrusio acetabuli-the most extreme form of global pincer femoroacetabular impingement-and cam femoroacetabular impingement. We demonstrate the feasibility of the arthroscopic correction of severe deformities and describe key surgical steps permitting central compartment access, subtotal acetabuloplasty, labral reconstruction, and femoroplasty of the right hip, followed by later subtotal acetabuloplasty, labral refixation, and femoroplasty of the left hip, with improved outcomes at 2 and 1 years, respectively, as measured by the nonarthritic hip score. Though challenging, global pincer impingement, even acetabular protrusion, may be successfully treated with dual-portal outpatient hip arthroscopy. The modified midanterior portal enables central compartment access and extended posterior "reach" in the arthroscopic treatment of major global pincer femoroacetabular impingement, potentially making this contraindication a historical one while respectfully challenging the "global" recommendation for open surgery in this setting.

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Citations

Jun 27, 2013·Arthroscopy Techniques·Dean K Matsuda, Dylan Hanami
Jun 7, 2014·Arthroscopy Techniques·Dean K MatsudaDylan Hanami
Oct 3, 2014·Arthroscopy Techniques·Dean K Matsuda, Angel Villamor
Apr 22, 2014·Arthroscopy Techniques·Amir A JamaliMeghan Sampson
Mar 25, 2016·Journal of Hip Preservation Surgery·Yan SimOlufemi R Ayeni
Jan 5, 2014·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Ira ZaltzAsheesh Bedi
Nov 12, 2013·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Marc R Safran, Noah P Epstein
Nov 22, 2012·Magnetic Resonance Imaging Clinics of North America·Itamar Botser, Marc R Safran
Aug 28, 2012·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Christopher Larson
May 29, 2012·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·James H LubowitzGary G Poehling
Mar 8, 2016·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Darren de SaOlufemi R Ayeni
Jun 12, 2013·Orthopedics·Ricardo Cuéllar GutiérrezAngel Oteo-Álvaro
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Jan 5, 2021·Sports Medicine and Arthroscopy Review·Christopher M LarsonAsheesh Bedi
Oct 30, 2021·Orthopaedics & Traumatology, Surgery & Research : OTSR·Michael Wettstein

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