The Orthobullets Podcast Podiums | Recon | Protrusio Acetabulum: Otto's Disease and Arthrokatadysis
Dec 30, 2025
Dr. Juan Suarez, an orthopaedic surgeon and educator specializing in hip reconstruction, dives into the complexities of protrusio acetabuli, also known as Otto's disease. He discusses the causes, from trauma to genetics, and explains how to navigate surgical challenges, including risks of over-medializing the acetabular cup. With insights on exposing techniques, he shares a compelling elderly patient case and offers tips on femoral strategy and bone grafting. Dr. Suarez makes preoperative planning sound exciting and essential for successful outcomes!
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Restore Native Hip Center
- Protrusio acetabuli is medial migration of the femoral head into the pelvis and can be primary or secondary to many causes.
- Over-medializing the cup reduces survivorship and raises revision risk, so restoring the native hip center is critical.
Use Anterior Approach And Bone Graft
- Use the anterior approach and fluoroscopy to aid accurate cup placement and avoid over-medialization.
- Bone graft the medial defect, create a peripheral ledge by reaming to depth, and secure the cup with screws when contact is limited.
Elderly Case With Moderate Protrusion
- He presented an 80-year-old female with Trendelenburg gait and a moderately protrusio right hip that he reconstructed with bone graft and two screws.
- The operation increased global offset and produced a tighter-feeling hip compared with standard osteoarthritis replacements.