A 52-year-old woman with seropositive rheumatoid arthritis has severe acetabular protrusio with medial migration of the femoral head past the Kohler line. She has intractable hip pain and inability to walk. The appropriate surgical management is:
- A Total hip arthroplasty with bone grafting of the medial wall defect ✓
- B Core decompression of the femoral head
- C Girdlestone resection arthroplasty
- D Birmingham hip resurfacing
Correct answer: A. Total hip arthroplasty with bone grafting of the medial wall defect
Explanation
Acetabular protrusio in RA requires total hip arthroplasty with reconstruction of the medial acetabular wall using bone graft (autograft/allograft) and a reinforcement ring or cage to restore the hip center of rotation. Core decompression is for avascular necrosis. Girdlestone is salvage for infection. Hip resurfacing is contraindicated in RA due to poor bone quality and inflammatory disease.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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