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

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.