AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2690-1919/167
1 Radiology Department, Usmanu Danfodiyo University, Sokoto
2 Radiology Department, Gombe State University, Gombe.
3 Radiology Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto
*Corresponding Author: SULE Muhammad Baba, Department of Radiology, Usmanu Danfodiyo University, Sokoto.
Citation: Sule MB, Shamaki AMB, Umar AU, Gele IH, Abdullahi A, et al (2021). Bilateral Protrusio Acetabuli in an Elderly Female Patient: The Plain Radiographic Features and a Case Report. J Clinical Research and Reports, 7(5); DOI:10.31579/2690-1919/167
Copyright: © 2021 SULE Muhammad Baba, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Received: 04 May 2021 | Accepted: 11 May 2021 | Published: 17 May 2021
Keywords: plain radiograph; pelvic cavity; degenerative changes; acetabulum; arthroplasty; arthrokatadysis; femoroacetabular impingement
Protrusion acetabuli is the medial protrusion of the acetabulum in to the pelvic cavity, also known as arthrokatadysis, more common in females and classified etiologically as primary (idiopathic) and secondary forms.
This is a 66-year-old female patient that presented for a plain radiograph of the pelvis and hip joints from a peripheral healthcare center on account of pain and inability to stand and move her waist and hips bilaterally, reduced movement of the legs and pain in the knees for more than three-year duration of onset.
The plain radiograph of the pelvis and both hip joints demonstrate reduced density of the demonstrated bones, medial protrusion of the medial wall of the acetabulum in to the pelvic cavity bilaterally (distance between the imaginary Kohler’s line and medial acetabular wall is about 22mm bilaterally; Degree: III), obliteration of the hip joints bilaterally, thickening and sclerosis of the acetabular walls and other articular margins, subarticular cysts on the femur, acetabulum and pelvic bones. The patient had no coexisting condition like rheumatoid arthritis, Marfan’s syndrome and psoriatic arthritis. A diagnosis of bilateral idiopathic protrusio acetabuli was made. The patient was advised on bilateral total hip arthroplasty to improve the symptoms.
We report a case of bilateral idiopathic protrusion acetabuli in an elderly female patient in order to describe the features of this condition radiographically.
Protrusion acetabuli is defined as that condition associated with medial displacement of the femoral head into the pelvis, with the medial aspect of the femoral head lying medial to the ilioischial line[1,2].
Protrusio acetabuli (PA) could either be primary (idiopathic) and secondary forms, it could either be unilateral or bilateral affecting one or both hips, and could be bilateral in conditions like rheumatoid arthritis, Paget’s disease, ankylosing spondylitis, Marfan’s syndrome and osteomalacia [1,3].
Primary or idiopathic PA is often reserved in cases where no causative factors found, often regarded as a diagnosis of exclusion, while the secondary PA has an identifiable cause, with numerous conditions like neoplastic, inflammatory, metabolic, infectious, traumatic and genetic causes are implicated in the cause of PA [3].
The presence of bilateral involvement of the hips and in the female gender, with racial and hereditary influence has been described for primary PA [4-6].
In PA, forces acting on the hip depend on some contributors, these are body weight, distance from the center of the femoral head to the midline and femoral neck-shaft angle. These factors are predictable on the basis of Pauwels theories of hip biomechanics [3,7].
Acetabular protrusion causes displacement of the hip rotational center inwardly, thereby causing limb shortening, decreased gluteal muscle tension, and associated extreme hip pain which may lead to an impairment in daily activities of the patient often requiring total hip arthroplasty [8].
The pincer effect is regarded as an infrequent subtype of femoroacetabular impingement, and protrusion acetabuli is by large the most severe pincer form and has a global involvement, and requiring surgical dislocation with acetabular rim trimming [4,9].
Imaging play’s role in PA, the anterior-posterior and lateral views of plain radiographs of the pelvis, these are needed in making the diagnosis, staging the severity and monitoring the disease progression [1,3].
This is a 66-year-old female patient that presented for a plain radiograph of the pelvis and hip joints from a peripheral healthcare center on account of pain and inability to stand and move her waist and hips bilaterally, activity-related pains, reduced movement of the legs and pain in the knees for more than three-year duration of onset.
No family history of similar or related problems, the patient has no history of seropositive arthritis.
On examination, the patient is oriented and conscious, not pale, anicteric, not dehydrated, not in obvious respiratory distress, has antalgic gait with a positive Trendelenburg sign.
The blood pressure was about 120/75mmHg, pulse rate of about 72beats/minute, respiratory rate of about 12cycles per minute and non-elevated jugular vein.
The packed cell volume was 38%, white cell count of about 11000/m3 and an erythrocyte sedimentation rate of 8mm/hr. The blood electrolyte was normal, blood urea was normal (3.5mmol/L) and the blood creatinine was also normal (76mmol/L). The uric acid level and calcium levels were also normal (3.0milligrams per deciliter and 8.8milligrams per deciliter).
The plain radiograph of the pelvis and both hip joints; (anterior-posterior and left lateral views) demonstrate reduced density of the demonstrated bones, medial protrusion of the medial wall of the acetabulum in to the pelvic cavity bilaterally (distance between the imaginary Kohler’s line and medial acetabular wall is about 22mm bilaterally; Degree: III), obliteration of the hip joints bilaterally, thickening and sclerosis of the acetabular walls and other articular margins, subarticular cysts on the femur, acetabulum and pelvic bones (figure 1 and 2).
The anterior-posterior view of the lumbar spine showed degenerative changes involving the lumbar spine with no syndesmophytes (figure 3). The patient had no coexisting condition like rheumatoid arthritis, Marfan’s syndrome and psoriatic arthritis. A diagnosis of bilateral idiopathic protrusio acetabuli was made.
The patient was advised on bilateral total hip arthroplasty as the surgical treatment to improve the symptoms and improve quality of life, the patient however did not consent to this treatment option as at the time of this report.
Protrusion acetabuli was initially described in 1824 by Otto in cadaveric studies as a deformity of the medial wall of the acetabulum with associated migration of the femoral head in to the pelvis [10,11]. The case under review presented with features suggesting migration of both acetabulum in to the pelvic cavity medially in keeping with protrusion acetabuli, thereby conforming to this literature.
Protrusion acetabuli has a female preponderance with a ratio of about 10:1, and often bilateral more common in individuals with advanced rheumatoid arthritis [10,12]. The case under review happens to be a female with bilateral affectation of the hips, but not a case of rheumatoid arthritis, thereby conforming to these literatures.
Protrusion acetabuli has been classified as etiologically as either primary or idiopathic accounting for about 75.3% of cases and as secondary PA in about 24.7% of cases, and also classified radiologically as either mild, moderate and severe forms [10,13]. The index case is most likely the primary form since an etiology has not been established, and from the radiographic features, this resembles a severe form of PA, thereby conforming to these literatures.
Protrusion acetabuli has also been graded on plain pelvic radiograph as either Degree I: when the measurement from the medial aspect of the acetabulum and Kohler’s line is between 1-5mm (light protrusion), Degree II: when the measurement from the medial aspect of the acetabulum and Kohler’s line is between 6-15mm (mild protrusion), and Degree III: when the measurement from the medial aspect of the acetabulum and Kohler’s line is more than 15mm (severe protrusion) [10,13]. The index case is most likely in the Degree III category as an estimated measurement of the distance from the Kohler’s line from the acetabulum is about 22mm, thereby conforming to these literatures.
In making a diagnosis of PA, clinical history with adequate clinical examination and radiological imaging are vital, confirmation of the diagnosis is mainly by standard plain radiographs of the hips; the anterior-posterior and lateral views, these make diagnosis, stage the disease progression with severity [1,3,10,13]. The case under review was diagnosed following plain radiographs of the hips, thereby conforming to these literatures.
The mainstay of treatment in adults is surgery, patients with significant arthritis and PA need total hip arthroplasty (THA) with non-structural bone grafting of the medial wall cavity for effectiveness [1,3]. The case under review was also advised for THA, but as at the time of this report the patient is yet to consent to this treatment modality.
Protrusion acetabuli is a condition associated with severe painful episodes especially with movement of the hip joint, this could either be primary or secondary, and when suspected, plain anterior-posterior radiograph of the hip joint plays an important role in confirmation of the diagnosis and monitoring the disease and its severity.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
