Bilateral Hip Protrusion?

[mel]

At the age of 20 I was diagnosed with bilateral hip protrusion at the Mayo Clinic in Rochester. They said that if I lost the weight(I was 293) that I could keep my hips longer, so I had the gastric bypass surgery and lost 110 lbs and have kept the weight off. It been six years and I had a baby two years ago and the pain has gotten really bad since my daughter was born. I know of no one else that has this problem so all I know is what the doctors tell me. I still walk on my own but my hips pop and cause severe pain where I can't move. I have asked that I get surgery but I am still waiting to see what the Mayo will say. I guess whatever advice someone can give me or whatever they know would be great. I guess I just want to know what to expect if I don't get the surgery, if they deny me. I just can't be a good mother and wife living like this. Thanks!

 

[Josephine]

Hello, mel - and welcome to the forum.

I am surprised you have kept going to so long with a protrusion. And bilateral at that.

I got these pictures to explain the situation to you (in case they hadn't already!)

This is a normal hip joint

And this is one with a 'protrusio', being thus called as the femoral head is beginning to break through the floor of the acetabulum or socket and 'protrude' into the pelvic cavity.

This must be incredibly painful for you. It is also a relatively uncommon development of arthritis and requires an extra implant to replace the floor of the acetabulum. This would either be stainless steel or titanium mesh or a Mueller ring which would be fixed in place with a screws and bone cement. A normal hip replacement is then employed in the usual way.

The surgery takes longer and is more complex than the usual THR although the post-op pain and rehab should be about the same.

Of course, obesity does have a significant role in this as whole procedure would be put at risk by the extra load bearing. You sound like you have done superbly well in your weight loss and I wouldn't expect that your current weight of 183lbs would be a contraindication for surgery now. As far as I know, there is little alternative treatment that would make a protrusio any more bearable to live with.

Do keep us posted on your progress.

 

[Jamie]

Josephine, your explanation was so very interesting and detailed. I tried googling to find out more about what this diagnosis meant, but couldn't find anything that was written in a clear way for us non-medical people to understand. You did it PERFECTLY. It is easier to provide support for one of our family when we can understand a little more about what they are going through. You always do that for us!

Mel, you are such a strong person to be going through this at your young age! Although I cannot offer anything more than support and prayers for you, I do send you that along with a big virtual ((((HUG))))))!!! Please keep in touch here on the forum. You and your family will continue to be in my thoughts and prayers. Keep asking and pressing the doctors until they can give you good answers to your questions!!

 

[mel]

Thank you, thank you, thank you! Finally someone who understands! That picture of the bilateral hip is exactly what mine looks like but I still have a small lining between the bones. I can't believe what a normal hip looks like.
Like you Jamie, I could not find any information that I understood on the internet. I did happen to google across this website and took a chance that I wasn't crazy! I do have to tell ya that many don't understand and I can't explain it to them.
There are many things that I dont know like the mesh that has to be inserted. I also wonder what it will be like in the future. Will I always have to be careful? Can I run again? How many surgeries will I face? I get my answer at the end of the week and I hope they will do something. ~just having someone to talk too that understands makes it easier~

 

[Jamie]

We're praying for you, honey.....be tough and GET THOSE ANSWERS. It might help if you write out your concerns and questions just so you remember to get everything addressed. Can't wait to hear how it goes!!! (((((((***MEGA HUGS**))))

 

[Josephine]

There are many things that I dont know like the mesh that has to be inserted. I also wonder what it will be like in the future. Will I always have to be careful? Can I run again? How many surgeries will I face? I get my answer at the end of the week and I hope they will do something. ~just having someone to talk too that understands makes it easier~

The mesh and/or ring is only a possibility and usually only used in extreme cases.
They sometimes use bone grafts as well to encourage the floor of the acetabulum to regenerate some. If they do that, they might need you to go extra easy on the leg for 2-3 months whilst the bone is healing. After that it should be as good as any other THR and as long lasting.

However, given your age of 26 years, I would predict the possibility that you could need at least one, possibly two revisions during your lifetime. Although you might find your surgeon, out of a degree of caution, will tell you you could need revisions every 10-15 years. I think this is an over-done caution but understandable since the medical profession always works from the notion of giving people the worst case scenario first and then anything less makes you feel you've won the lottery!

 

[mel]

My doctor called and said the best option for me would be re-lining. So anyone know what that is? I wont get to go see him yet ,as it is far away. He still doesn't want to do the hip replacements because of my age. Is this procedure going to help with the pain or just give me more time? Thanks for all your concerns and help it means a lot to me and my family.

 

[Josephine]

Hmmm - not so sure about that, mel. If you have a protrusio it needs some support on the acetabular floor. A relining is - if I am thinking what he is thinking - simply a cap on the femoral head. The acetabulum still has to be shaped to take the liner and if the floor is thin then that would not be a good option.

However, your doctor is not the orthopaedic expert, the surgeon is. So I would suspend judgment until you seem him and hears what he has to say.

 

[Sonia S.]

At the age of 20 I was diagnosed with bilateral hip protrusion at the Mayo Clinic in Rochester. They said that if I lost the weight(I was 293) that I could keep my hips longer, so I had the gastric bypass surgery and lost 110 lbs and have kept the weight off. It been six years and I had a baby two years ago and the pain has gotten really bad since my daughter was born. I know of no one else that has this problem so all I know is what the doctors tell me. I still walk on my own but my hips pop and cause severe pain where I can't move. I have asked that I get surgery but I am still waiting to see what the Mayo will say. I guess whatever advice someone can give me or whatever they know would be great. I guess I just want to know what to expect if I don't get the surgery, if they deny me. I just can't be a good mother and wife living like this. Thanks!

Hello Mel,
My name is Sonia from Sydney Australia, i am 44yrs.
I had moderately severe and bilateral protrusio-acetabuli all my life.
What you are discribing is what i had up until last year and Josephine's explanation is exactly what it's about, only my X-ray looked worse.
Now listen to me: Find yourself a good surgeon. Do the surgery one at a time preferably (3 months apart).
Because of your young age, i recommend ceramic on ceramic.
Then do your physio regularly....
YOU WILL BE A NEW WOMEN AND ENJOY LIFE AS YOU HAVE NEVER EXPERIENCED BEFORE!!!
Trust me: BEEN THERE! DONE THAT! WHAT A DIFFERENCE!
If finally understand that people who have no hip problem take things for granted.
I wish you good luck and best wishes. Sonia

 

[Josephine]

Well said, Sonia!

 

[Sonia S.]

Well said, Sonia!

Honestly, I went through hell and came back! But it was all worth it! All the posts that I read are all flash backs. Thank God it's all over. I am enjoying the precious time that i have left in perfect quality of life. Thank to the wonderful medical science that gave me my life back. Regards, Sonia.

 

[Lesley Ann]

Hi All,

I am new to this site and came across your posts in trying to research Protrusio Acetabuli from the patients perspective. I really appreciated reading Sonia's post, thank you. I have had progressive hip pain and restricted movement since age 26 (I am now 50) and finally toodled in to see the orthopedic doctor this past week to see if the "pain is gain" thing was really worth it, and just to ask what exercise activity really is best, so that I could reduce my Aleve intake. So he really knocked my socks off when he said I had Protrusio Acetabuli and that I needed to schedule the first THR within the next three months, he mentioned not waiting to long (and you can see how well I listen) as there is a chance "something" could fracture. (Is there something that could fracture?). Thank you all for giving me the opportunity to hear about your trials with this, and that I am not alone with this dilemma.

Thanks

 

[Josephine]

Yes, indeed there is and it would have been better if he had explained it to you whilst showing you your xrays, but I'll do my best here.

The acetabulum is the socket part of the hip.

You can see where the upper line marked "healthy cartilage" points, the bone is at it's thinnest. We call this the 'floor' of the acetabulum and it bears a fair bit of your body weight when you stand. On the other side of the acetabular floor is the pelvic cavity.

Here you can see how the femoral head is beginning to break through this floor. At this stage, the floor needs to be reinforced with extra implants, something as basic as wire mesh, in order to restore the normal anatomy.

Now don't get too scared by this. It's a process that can take some months to occur and people have walked around on bilateral (both sides) protrusios for years before getting them dealt with.

Do post any questions you have and I will do my best to answer them.

 

[Sonia S.]

Hi All,

I am new to this site and came across your posts in trying to research Protrusio Acetabuli from the patients perspective. I really appreciated reading Sonia's post, thank you. I have had progressive hip pain and restricted movement since age 26 (I am now 50) and finally toodled in to see the orthopedic doctor this past week to see if the "pain is gain" thing was really worth it, and just to ask what exercise activity really is best, so that I could reduce my Aleve intake. So he really knocked my socks off when he said I had Protrusio Acetabuli and that I needed to schedule the first THR within the next three months, he mentioned not waiting to long (and you can see how well I listen) as there is a chance "something" could fracture. (Is there something that could fracture?). Thank you all for giving me the opportunity to hear about your trials with this, and that I am not alone with this dilemma.

Thanks

Hello Lesley Ann,
I found out that i had Bilateral Protrusio at 22yrs old in 1986 (by accident). At that time, My hips didn't bothered me much but i new something was wrong as my legs wouldn't spread out as a normal person. My second child was delivered by C-section because my pelvic was too small. By then my hips had protruded in the pelvic cavity and there was no room for the baby's head to go through therefore the doctor said I could only have a C-section. I was very lucky with my first baby to have had her as a normal delivery (at that time i didn't know that there was any problem). When i was pregnant with my second child the doctor was chocked as how did the first baby passed through but he said that the only explanation was that the baby's head must've been small and it was. Then eventually, i started to have restrictions more and more. When i reached 43 years old, i coudn't bend down to do my own shoes laces, wear socks or cut toe nail. If someone pushed me i had no balance as my hips were so stiff and i would fall like a rock. My ankles were doing the work of the hips and many times i would sprain my ankles. I have permanent swelling there.That's when i decided to do something about it. I did my own researched, talked with people who had hip replacement and finally decided to have it myself. Here i am now at 44 with brand new hips (ceramic on ceramic). No more sleepless night with soreness in the groin where it wake me many times, no more restrictions, i can do or be like a normal person. The best is no pain only FREEDOM! THE BEST THING I HAVE DONE. I was really disabled. When i think at those days, what a difference! I was due to have belateral THR but because the first hip was so difficult the surgeon couldn't do the other hip aswell and decided that the second hip should be done at 3 months interval. And that's what happenned. It is a big operation a bit more complicated than the common hip replacement as the surgeon need to reconstruct a new area for the new hip to sit on. Not easy but makable! Found a good surgeon and do the surgery, i'll tell you it works. Best wishes, Sonia.

 

[protrusio]

Hi My daughter was only 14 years old when she was diagnosed with severe protrusio acetabuli. She has been given Birmingham Hip Resurfacing on both hips and she is now 16 years old and doing very well. Prior to her surgery she could not walk and required a wheelchair to be mobile. Have you researched hip resurfacing? You are also young and resurfacing might be appropriate for you. I would be happy to give you more information if you are interested. Lynn

 

[Lesley Ann]

Hi, yes I had a second opinion last week and my only option is to have them replaced. They will do one at a time rebuilding my acetabuli with the femur heads. My right hip is scheduled for Sept 24. Thank you all for your posts they are invaluable.
Thanks

 

[Josephine]

Do stay in touch. We will be thinking of you!