Dr. Maurice Pomeranz (1892-1980) was Director of Radiology at the Hospital for Joint Diseases in New York City from 1948 until his retirement in 1959 (Fig 1). He had been hired in 1923 in anticipation of the opening of the new Hospital for Joint Diseases in 1924 on Madison Avenue between 123rd and 124th Streets (Fig 2). In his 37 years at HJD, he wrote a number of articles including this month's Classic,2 and one with the eminent pathologist, Dr. Henry Jaffe.1 He continued his work as a consulting radiologist until his death in 1980.Fig 1: Drs. Maurice Pomeranz (on left) and Herman B. Philips, the other attending radiologist, in the new radiology suite at the recently built Hospital for Joint Diseases, 1924. Figure reprinted with permission of Dr. Joseph Zuckerman, Professor and Chairman of the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases.Fig 2: The newly built Hospital for Joint Diseases at 1919 Madison Avenue in 1924. The hospital was constructed at the site of the previous clinic built in 1906; that structure and several additions had been razed to make way for the new building. Figure reprinted with permission of Dr. Joseph Zuckerman, Professor and Chairman of the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases.Richard A. Brand, MD References 1. Jaffe HL, Pomeranz MM. Changes in the bones of extremities amputated because of arterial vascular disease. Arch Surg. 1934;29:566-588. 2. Pomeranz MM. Intrapelvic protrusion of the acetabulum (Otto pelvis). J Bone Joint Surg Am. 1932;14:663-686. The condition to be described may be defined as a non-traumatic, chronic progressive arthritis of the hip joint, characterized by intrapelvic protrusion of the acetabulum and head of the femur. This lesion was recognized more than a century ago (1824) by Otto1, and, although occurring infrequently, is of sufficient importance to orthopaedic surgery and obstetrics to justify a review of the subject. An indication of the timeliness of the latter was demonstrated recently by the report42, of a case designated as “an unusual bilateral condition of the acetabulum”, which apparently presented the typical features of an Otto pelvis. It should be stated at the outset that the association of Chrobak's name with that of Otto in connection with this disease is misleading, the former name having been attached by Eppinger12, merely as a birthday tribute to Chrobak. Diagnosed initially by Otto as “an abnormal gouty manifestation”, this deformity has since been referred to by its reporters under the following diversified captions; Gurlt (quoted by Henschen29) referred to it as “a coxalgia with an acetabular fracture”; Eppinger (1903) suggested the term “Coxarthrolisthesis-Becken”; Kuliga (1905) referred to it as “an osteo-arthritis deformans”; Breus and Kolisko (1912), as “a peculiar destructive coxitis preferably localized in the acetabulum”; Schlagenhaufer (1908), as “gonorrhoeal arthritis”; Henschen (1909), as “caused by various processes of coxitis and neuropathy”; Schertlin (1911), as “a juvenile osteo-arthritis deformans”; Kienböck (1911) reported “an unusual deformity of the hip with protrusion of the acetabulum attributable to gonorrhoeal arthritis and tabetic arthropathy”; Chiari (1912) referred to this affection as “a tabetic coxarthritis”; Hertzler (1922), Pomeranz (1925), and Lewin (1925), as “an osteo-arthritic protrusion of the acetabulum”; Doub (1929), as “an intrapelvic protrusion of the acetabulum”; etc. This disease was originally described by Otto1 in 1824. As his description of a pelvis seen in an anatomical museum is the basis of all subsequent studies, the translation of it is presented as follows: "This pelvis from an adult woman is, on the whole, fairly normal in size and build, its chief characteristic is the very deep insertion of both femoral heads in the acetabula; so that the floors of the latter protrude far into the pelvis and are at the same time imperfectly ankylosed. “The right acetabulum protrudes into the pelvis like half an orange. It forms a round, smooth, fairly thick-walled, bony shell (all diameters of the base are two and three-quarters inches broad; from that point it protrudes into the pelvis one and one-half inches). At the crest-which approximately corresponds to the center of the acetabular fossa-is an irregular circular defect, measuring one and one-half inches, probably due to absorption, initially possibly closed by membrane, but now supplying communication between the acetabulum and abdominal cavity. The lower marginal portion of the ilium protrudes like a ball into the iliac notch, due to the extended acetabulum, so that its ordinary width of about two inches, as well as the distance between the tip of the os sacrum and the opposite iliac margin, is reduced to one inch. The acetabulum protrudes so far into the pelvis that it contains not only the head but also the normally long neck of the femur, and the upper acetabular margin articulates with the great trochanter. The entire inner aspect of the acetabulum is smooth, also the head of the femur; both are devoid of cartilaginous covering, and have the abraded and polished appearance of some gouty joints; only the portion of the femoral head opposite the acetabular defect is roughened and eroded by absorption. The acetabular margin is rough and uneven, slightly thickened, and so constricts the femoral head that the larger head cannot be removed from the cavity of the joint,-the transverse ligament of the acetabulum is ossified. (Since the roughened large trochanter grates on the roughened acetabular margin, and since the femoral neck is also somewhat angular and the small trochanter hits the sciatic tuberosity on backward flexion of the femur, the femur itself can be rotated only slightly forward and inward, but not outward and backward; thus the joint is so restricted that the abdomen and thighs form a right angle in the standing position.) “The left hip joint behaves much like the right; its acetabulum does not protrude, however, quite so far into the pelvis, but only three-quarters of an inch; the neck of the femur also has not entirely dropped down into the acetabulum, yet, since the margin is thicker than in the right hip and more constricted, and since the neck of the femur shows several protuberances at the points of friction with the acetabular margin, movement is still more restricted; the arc described by excursion of the left knee anteroposteriorly is only seven inches long; the inner bilateral femoral tuberosities can be separated only for a distance of about four to five inches. In the left hip joint the transverse ligament is ossified and is three-quarters of an inch in breadth. “The right sacro-iliac symphysis is ankylosed for about one inch, and because the right femoral head is deeply inserted, the lower end of the right femur appears to be shorter than the left by one inch. “From the above described deformity and the whole appearance of the bone of this specimen, which is of interest to obstetricians, I believe the condition due to abnormal gout.” The reproductions Figures 1 and 2 (not shown) were obtained from Breus and Kolisko27 and illustrate the typical deformity. ETIOLOGY AND PATHOGENESIS Differences of opinion regarding this disease have been occasioned chiefly: (1) by the wide range of etiological factors held to be responsible for the condition, and (2) by variations in the pathological findings reported. Based on the theory of various investigators that numerous transitional forms are possible, it appears that opinions might easily be influenced by the particular stage during which the process is noted; also by the fact that quantitative and individual fluctuations in the severity of the lesions must be reckoned with. Then, too, transitional forms may be missed at autopsy, although present, since the hip is not usually investigated post mortem. A review of the literature in connection with the Otto pelvis points to an overwhelming majority who believe that it is not a disease entity, but the end result of an inflammatory process; Wolfsohn and Brandenstein24, Schlagenhaufer21, Bischoff25, Schertlin23, Doub41, Henschen18, Kienböck26, Breus and Kolisko27, Kuliga13, Pomeranz34, Loebel37, Zwicker38, and are in with this of the condition as an of a juvenile osteo-arthritis other chronic the deformity years from the are to be in the including the the the etc. as the gouty and are the other factors from an etiological to be appears to be the on the subject. his of four anatomical he the affection to a in the acetabular of the of a he it a of the acetabulum in which the does not but is into the he this condition from the of the of the of the in of the four he described in his opinion at the importance of the cartilaginous to be case is of since it on the of the of following and at a typical Otto deformity was This it an osteo-arthritis and does not with theory of a This was the case which the and pathological In the intrapelvic protrusion with and a was A was on head a defect was This defect in a This case that not in the of the with that it was of gonorrhoeal The basis of the condition, however, is suggested by several including and although from the etiological to the of a protrusion in the in not only in the of this but also and and the affection as an the of in four of the which he he also the and his of the tabetic of the disease. and are in are due to of the hip with of the he described as Otto the protrusion and of a Otto pelvis. and to the tabetic and the etiological connection of of interest in that it may the of more in described a from a woman in the of The acetabular into the pelvis. In of the of this the of the condition and the to who in it to The latter it as a in a subsequent stated that he was to the and the of the the other Breus and Kolisko27 the tabetic theory because of the in the right hip joint in an destructive protrusion in the left hip this case was and as due to tabetic have the by the Schlagenhaufer21, in described a case which has been This was a years of in hip joint the was at The joint were of a typical destructive with protrusion of the acetabulum and the head of the femur. that the condition he presented was the of a gonorrhoeal this that other inflammatory processes than one of might also the same case was by as the only case of intrapelvic acetabular protrusion of gonorrhoeal to that time Breus and Kolisko27 described of Otto pelvis. as the only etiological a gonorrhoeal and of a tabetic subsequent that the was the only of all of the and in this that protrusion of the acetabulum was a in gonorrhoeal he one of his to this case he due to a of and was that the gonorrhoeal arthritis of the acetabulum with of the and that of the bone with and protrusion of the acetabulum and of the an intrapelvic protrusion an gonorrhoeal The importance of as a in the of this deformity has been by several In of the was at reported the case of a who of of the and and 1 of as a case of a The by in in a woman of who an years to the of the has much This also had which during the deformity in this case to and he and as due to a of and It is that case was in the reported by and are in reported seven of in the literature and that the usually was not but at of the acetabulum and were usually and the acetabular were and The heads of the were usually in to in the of the joint and in the described the case of a years of who had a in the right at a bony the acetabulum, the size of a and by A was the This following a in of of the reported in and in only had the from the pelvis to the femur. He the of and referred in a years of who was with in the lower abdomen and four was by as an of the bony this that the process had its in the to the acetabulum and and in intrapelvic protrusion of the described typical occurring in both of had been for of the In this he to a case reported by and the deformity of The as by Henschen18, in protrusion of the of the of the acetabulum with of the femoral head and its into the acetabulum, and of the the other four of the process have been described by Breus and A localized destructive of the bony An of the head and neck of the femur in the Intrapelvic protrusion of the acetabular due to from the femoral A in a newly acetabular and intrapelvic including believe that of the acetabular during the that of the during the and during the with Otto protrusion may be A of this is seen in that the following may be at of the A. B. with Breus and with and 2 of Breus and This stage may be by various bony of the joint, by Henschen and Breus and Kolisko are that in the of this disease the in the acetabulum, the femoral head and Doub41, and the are in with this the other Otto1, and Schlagenhaufer21, have the in the femur, the head in some of and with and in of the reported to that and of only were by to be is probably 2 of is that time have been and of to be typical of intrapelvic in all approximately of Otto pelvis reported to the the literature which has on the is this affection had been by the the on the subject. In of the this deformity in It is thus as in as in in have been the one of a of the following reported in under years of case in a in a of in a woman of and two and years of and 2 and The disease was in of the reported In the condition was and in one case the was not stated by the AND The chief of the case is that of a which has for years to the the a which so that the with a and may it to the to the deformity is great and the condition of long all at the hip restricted and is of and of the femur. in particular appears to be restricted in the disease. may the trochanter the pelvis the trochanter the The flexion deformity that may be so great that the femur and pelvis form a right to the of the femur, of the and may be present, on the severity of the lesion in the abdominal a into the pelvis from the inner aspect of the hip joint, may be above and in the may be demonstrated on The in may be by The in the The disease in an protrusion of the acetabulum, so that it into the pelvis as a The of protrusion from a to four five in As the acetabulum it inward, and forward so that it may above the of the the and at and In the protrusion to the joint and, as a of the pelvis The inner of the acetabulum may be in as an As it into the pelvis, a process is the joint by the of a on the inner aspect of the acetabulum to its The of the acetabulum outward the neck of the femur as irregular In the typical is of the of the femoral This to be a since the femoral head must its This is in the of all although of the of the cartilaginous of the may from the of the It may and at other slightly a outward from the of the bony are which the femoral The acetabular with the from the the femoral head the The of in a must be As the femur the acetabulum, appears to be of its This however, is more than and is due to two the of the acetabulum, by the and the protrusion from the femoral head which at the of the As the head of the femur is the acetabulum, the the of the pelvis and The trochanter on the of the in the of the acetabular and the trochanter the The of the the femur cannot be rotated outward In the acetabulum may two and fairly large for the femoral and a for the trochanter. The of the at the of the pelvis the deformity. of the femur is its is and the on the inner of the acetabulum ossified. The stage of the disease is thus and the deformity is 1. number and on arthritis of the left In the a gonorrhoeal his left and he was to his on the He was by his and the his he a following which he in the left He was to an he four At this hospital a was to the hip for and his at the same The but the hip ankylosed. In he hospital and and for This but the of the hip At still which he of the hip was under a Orthopaedic in flexion of the left hip was to only about was and was of the to about three-quarters of an inch. was the but a was on the inner aspect of the The joint was not and were in Figure (not 2. and on arthritis of the left knee and to was to by This was by in left and hip in the which the to in left hip and lower Orthopaedic who was apparently in great in on left with In the right lower was of but on hip was held but be although of in the hip and was left on on was and his in the his from to and were of of on in Figure a from the which was the deformity of the left hip was and A was which was removed on In the was and at that a typical intrapelvic protrusion of the left acetabulum was not 1924. on The previous was The previous was of as a in the latter half of he was and was to a base he was for a condition with The that the condition was a than a He in the hospital for one and was as of was and at that hospital were as were also at from the base he was with a in the left hip which so as to This was and localized in the left It was on and on and was somewhat by At the end of one he was to be and the had but some The years a of this a of by to be by so that at time of only was in the left Orthopaedic condition and were for the left was some as well as a of all about the hip in flexion and and were and 1924 not number in the osteo-arthritis of both in the sacro-iliac and hip for the during the The appears to in the sacro-iliac and hip and down the to be on the left Orthopaedic with a and of the thighs were flexion were flexion was only both thighs were to be ankylosed. was both sacro-iliac not number in clinic in the and right the years had irregular in the and right during The was in from the both The in the the sacro-iliac was in and only by and The in the and right knee was in the had of both Orthopaedic with a was of all in both on the right and in particular to be was a of the right knee joint in were in both and of the the heads of the were fairly and typical osteo-arthritic protrusion of the of the right sacro-iliac joint, and of the left sacro-iliac joint not number in the osteo-arthritis of the The of the condition about with in both the the had been more and to be on the right apparently in the and down the the had been some in on the right the had been a Orthopaedic in both was was a present, on both was of not The of a gonorrhoeal by of the and hip 1 as of gonorrhoeal The shows a typical intrapelvic protrusion of the 2 is of This an arthritis of the hip following and an at the time of the joint due to of the with of the the was not as the it is at to that the condition an The destructive process as demonstrated by the itself in its by of the acetabulum the femoral head of the the deformity had and was demonstrated at this it is from the not shown) that the had not in the femoral but in the This case the of the disease and the deformity. The of is that of a typical intrapelvic This case has been reported. The was that the in the newly inner of the acetabulum are small and that the bone is a to that seen in in long The of was probably the The of a of as well as the and of a process in the and hip point to a with the lesions of the in and In the hip in the process as a In the review of the it is that is regarding the of the regarding its appears to be due to by various to it a disease entity, having as its a this as A of the the fact that the condition may be by process which the acetabulum and the femoral head disease in a localized of the acetabulum can the the femoral head its that this is The destructive however, must not be and must bone have seen of all the in the the only one in which the gonorrhoeal of the disease appears to have been the findings in a case as be and to are to this other has the from an It is the of orthopaedic that gonorrhoeal are and of result in The of of intrapelvic protrusion are of a and not progressive deformity. gonorrhoeal it is bony in the that in an Otto pelvis appears to be due to numerous small bone the in other Schlagenhaufer that intrapelvic protrusion of the acetabulum was in he its to the of it is that and might the its on subsequent be one the of more intrapelvic protrusion in of gonorrhoeal arthritis of the can be stated for the In this is an and the joint and result in The Otto deformity and shows only of but is, as a of the of the In all the femoral heads and the of the were still although the were A of the hip is during the stage of a This however, is usually and and not the of in intrapelvic protrusion in is is of this is that the process is and to of and the process with with in the the process the femoral head and in its and of the to the of the head must be in to the in this the in the of the head the of the deformity. It is to that in by itself to the in that it the of the femur on an the other the since are not of bone in an acetabulum, the of a inflammatory In this the not be in be and, as a and the for the of the deformity. of intrapelvic protrusion have been reported in from the process in one is to believe that intrapelvic protrusion are In the process under the acetabular in with and of the to the of the deformity. however, the is not that of The in all the is the of a deformity in a usually at a time coxitis is the of bone and the of bone in the hip to and in the bones of the pelvis, result in intrapelvic protrusion of the In disease have the of with in and of the pelvis, the bone the of the deformity. must however, that the deformity is but a of a and in disease and the of an intrapelvic protrusion is by the both of the pelvis and In the protrusion of the acetabulum is by the and of the characteristic of this disease. theory of a that the cartilaginous of the acetabulum and are into the pelvis by the of the head of the femur. In the this deformity had not been have to the protrusion to an as disease the cartilaginous of the acetabulum and in its the whole, it to two of intrapelvic (1) an probably in (2) a chronic occurring in the of in an of the hip the has the acetabular of the hip joint, the femoral head and the protrusion the is and the head of the femur and the acetabulum, is of the head and bony may result the deformity The may in and in as and disease. In this the hip lesion is but an in the deformity. of the presented of an process in the sacro-iliac joint and and in the and In the had of which by years the of the hip it to that the to the not the Otto pelvis an but arthritis of the hip must of the and of this lesion of the hip The to the of of the New York of in the
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Dr. Maurice Pomeranz (1892-1980) was Director of Radiology at the Hospital for Joint Diseases in New York City from 1948 until his retirement in 1959 (Fig 1). He had been hired in 1923 in anticipation of the opening of the new Hospital for Joint Diseases in 1924 on Madison Avenue between 123rd and 124th Streets (Fig 2). In his 37 years at HJD, he wrote a number of articles including this month's Classic,2 and one with the eminent pathologist, Dr. Henry Jaffe.1 He continued his work as a consulting radiologist until his death in 1980.Fig 1: Drs. Maurice Pomeranz (on left) and Herman B. Philips, the other attending radiologist, in the new radiology suite at the recently built Hospital for Joint Diseases, 1924. Figure reprinted with permission of Dr. Joseph Zuckerman, Professor and Chairman of the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases.Fig 2: The newly built Hospital for Joint Diseases at 1919 Madison Avenue in 1924. The hospital was constructed at the site of the previous clinic built in 1906; that structure and several additions had been razed to make way for the new building. Figure reprinted with permission of Dr. Joseph Zuckerman, Professor and Chairman of the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases.Richard A. Brand, MD References 1. Jaffe HL, Pomeranz MM. Changes in the bones of extremities amputated because of arterial vascular disease. Arch Surg. 1934;29:566-588. 2. Pomeranz MM. Intrapelvic protrusion of the acetabulum (Otto pelvis). J Bone Joint Surg Am. 1932;14:663-686. The condition to be described may be defined as a non-traumatic, chronic progressive arthritis of the hip joint, characterized by intrapelvic protrusion of the acetabulum and head of the femur. This lesion was recognized more than a century ago (1824) by Otto1, and, although occurring infrequently, is of sufficient importance to orthopaedic surgery and obstetrics to justify a review of the subject. An indication of the timeliness of the latter was demonstrated recently by the report42, of a case designated as “an unusual bilateral condition of the acetabulum”, which apparently presented the typical features of an Otto pelvis. It should be stated at the outset that the association of Chrobak's name with that of Otto in connection with this disease is misleading, the former name having been attached by Eppinger12, merely as a birthday tribute to Chrobak. Diagnosed initially by Otto as “an abnormal gouty manifestation”, this deformity has since been referred to by its reporters under the following diversified captions; Gurlt (quoted by Henschen29) referred to it as “a coxalgia with an acetabular fracture”; Eppinger (1903) suggested the term “Coxarthrolisthesis-Becken”; Kuliga (1905) referred to it as “an osteo-arthritis deformans”; Breus and Kolisko (1912), as “a peculiar destructive coxitis preferably localized in the acetabulum”; Schlagenhaufer (1908), as “gonorrhoeal arthritis”; Henschen (1909), as “caused by various processes of coxitis and neuropathy”; Schertlin (1911), as “a juvenile osteo-arthritis deformans”; Kienböck (1911) reported “an unusual deformity of the hip with protrusion of the acetabulum attributable to gonorrhoeal arthritis and tabetic arthropathy”; Chiari (1912) referred to this affection as “a tabetic coxarthritis”; Hertzler (1922), Pomeranz (1925), and Lewin (1925), as “an osteo-arthritic protrusion of the acetabulum”; Doub (1929), as “an intrapelvic protrusion of the acetabulum”; etc. This disease was originally described by Otto1 in 1824. As his description of a pelvis seen in an anatomical museum is the basis of all subsequent studies, the translation of it is presented as follows: "This pelvis from an adult woman is, on the whole, fairly normal in size and build, its chief characteristic is the very deep insertion of both femoral heads in the acetabula; so that the floors of the latter protrude far into the pelvis and are at the same time imperfectly ankylosed. “The right acetabulum protrudes into the pelvis like half an orange. It forms a round, smooth, fairly thick-walled, bony shell (all diameters of the base are two and three-quarters inches broad; from that point it protrudes into the pelvis one and one-half inches). At the crest-which approximately corresponds to the center of the acetabular fossa-is an irregular circular defect, measuring one and one-half inches, probably due to absorption, initially possibly closed by membrane, but now supplying communication between the acetabulum and abdominal cavity. The lower marginal portion of the ilium protrudes like a ball into the iliac notch, due to the extended acetabulum, so that its ordinary width of about two inches, as well as the distance between the tip of the os sacrum and the opposite iliac margin, is reduced to one inch. The acetabulum protrudes so far into the pelvis that it contains not only the head but also the normally long neck of the femur, and the upper acetabular margin articulates with the great trochanter. The entire inner aspect of the acetabulum is smooth, also the head of the femur; both are devoid of cartilaginous covering, and have the abraded and polished appearance of some gouty joints; only the portion of the femoral head opposite the acetabular defect is roughened and eroded by absorption. The acetabular margin is rough and uneven, slightly thickened, and so constricts the femoral head that the larger head cannot be removed from the cavity of the joint,-the transverse ligament of the acetabulum is ossified. (Since the roughened large trochanter grates on the roughened acetabular margin, and since the femoral neck is also somewhat angular and the small trochanter hits the sciatic tuberosity on backward flexion of the femur, the femur itself can be rotated only slightly forward and inward, but not outward and backward; thus the joint is so restricted that the abdomen and thighs form a right angle in the standing position.) “The left hip joint behaves much like the right; its acetabulum does not protrude, however, quite so far into the pelvis, but only three-quarters of an inch; the neck of the femur also has not entirely dropped down into the acetabulum, yet, since the margin is thicker than in the right hip and more constricted, and since the neck of the femur shows several protuberances at the points of friction with the acetabular margin, movement is still more restricted; the arc described by excursion of the left knee anteroposteriorly is only seven inches long; the inner bilateral femoral tuberosities can be separated only for a distance of about four to five inches. In the left hip joint the transverse ligament is ossified and is three-quarters of an inch in breadth. “The right sacro-iliac symphysis is ankylosed for about one inch, and because the right femoral head is deeply inserted, the lower end of the right femur appears to be shorter than the left by one inch. “From the above described deformity and the whole appearance of the bone of this specimen, which is of interest to obstetricians, I believe the condition due to abnormal gout.” The reproductions Figures 1 and 2 (not shown) were obtained from Breus and Kolisko27 and illustrate the typical deformity. ETIOLOGY AND PATHOGENESIS Differences of opinion regarding this disease have been occasioned chiefly: (1) by the wide range of etiological factors held to be responsible for the condition, and (2) by variations in the pathological findings reported. Based on the theory of various investigators that numerous transitional forms are possible, it appears that opinions might easily be influenced by the particular stage during which the process is noted; also by the fact that quantitative and individual fluctuations in the severity of the lesions must be reckoned with. Then, too, transitional forms may be missed at autopsy, although present, since the hip is not usually investigated post mortem. A review of the literature in connection with the Otto pelvis points to an overwhelming majority who believe that it is not a disease entity, but the end result of an inflammatory process; Wolfsohn and Brandenstein24, Schlagenhaufer21, Bischoff25, Schertlin23, Doub41, Henschen18, Kienböck26, Breus and Kolisko27, Kuliga13, Pomeranz34, Loebel37, Zwicker38, and are in with this of the condition as an of a juvenile osteo-arthritis other chronic the deformity years from the are to be in the including the the the etc. as the gouty and are the other factors from an etiological to be appears to be the on the subject. his of four anatomical he the affection to a in the acetabular of the of a he it a of the acetabulum in which the does not but is into the he this condition from the of the of the of the in of the four he described in his opinion at the importance of the cartilaginous to be case is of since it on the of the of following and at a typical Otto deformity was This it an osteo-arthritis and does not with theory of a This was the case which the and pathological In the intrapelvic protrusion with and a was A was on head a defect was This defect in a This case that not in the of the with that it was of gonorrhoeal The basis of the condition, however, is suggested by several including and although from the etiological to the of a protrusion in the in not only in the of this but also and and the affection as an the of in four of the which he he also the and his of the tabetic of the disease. and are in are due to of the hip with of the he described as Otto the protrusion and of a Otto pelvis. and to the tabetic and the etiological connection of of interest in that it may the of more in described a from a woman in the of The acetabular into the pelvis. In of the of this the of the condition and the to who in it to The latter it as a in a subsequent stated that he was to the and the of the the other Breus and Kolisko27 the tabetic theory because of the in the right hip joint in an destructive protrusion in the left hip this case was and as due to tabetic have the by the Schlagenhaufer21, in described a case which has been This was a years of in hip joint the was at The joint were of a typical destructive with protrusion of the acetabulum and the head of the femur. that the condition he presented was the of a gonorrhoeal this that other inflammatory processes than one of might also the same case was by as the only case of intrapelvic acetabular protrusion of gonorrhoeal to that time Breus and Kolisko27 described of Otto pelvis. as the only etiological a gonorrhoeal and of a tabetic subsequent that the was the only of all of the and in this that protrusion of the acetabulum was a in gonorrhoeal he one of his to this case he due to a of and was that the gonorrhoeal arthritis of the acetabulum with of the and that of the bone with and protrusion of the acetabulum and of the an intrapelvic protrusion an gonorrhoeal The importance of as a in the of this deformity has been by several In of the was at reported the case of a who of of the and and 1 of as a case of a The by in in a woman of who an years to the of the has much This also had which during the deformity in this case to and he and as due to a of and It is that case was in the reported by and are in reported seven of in the literature and that the usually was not but at of the acetabulum and were usually and the acetabular were and The heads of the were usually in to in the of the joint and in the described the case of a years of who had a in the right at a bony the acetabulum, the size of a and by A was the This following a in of of the reported in and in only had the from the pelvis to the femur. He the of and referred in a years of who was with in the lower abdomen and four was by as an of the bony this that the process had its in the to the acetabulum and and in intrapelvic protrusion of the described typical occurring in both of had been for of the In this he to a case reported by and the deformity of The as by Henschen18, in protrusion of the of the of the acetabulum with of the femoral head and its into the acetabulum, and of the the other four of the process have been described by Breus and A localized destructive of the bony An of the head and neck of the femur in the Intrapelvic protrusion of the acetabular due to from the femoral A in a newly acetabular and intrapelvic including believe that of the acetabular during the that of the during the and during the with Otto protrusion may be A of this is seen in that the following may be at of the A. B. with Breus and with and 2 of Breus and This stage may be by various bony of the joint, by Henschen and Breus and Kolisko are that in the of this disease the in the acetabulum, the femoral head and Doub41, and the are in with this the other Otto1, and Schlagenhaufer21, have the in the femur, the head in some of and with and in of the reported to that and of only were by to be is probably 2 of is that time have been and of to be typical of intrapelvic in all approximately of Otto pelvis reported to the the literature which has on the is this affection had been by the the on the subject. In of the this deformity in It is thus as in as in in have been the one of a of the following reported in under years of case in a in a of in a woman of and two and years of and 2 and The disease was in of the reported In the condition was and in one case the was not stated by the AND The chief of the case is that of a which has for years to the the a which so that the with a and may it to the to the deformity is great and the condition of long all at the hip restricted and is of and of the femur. in particular appears to be restricted in the disease. may the trochanter the pelvis the trochanter the The flexion deformity that may be so great that the femur and pelvis form a right to the of the femur, of the and may be present, on the severity of the lesion in the abdominal a into the pelvis from the inner aspect of the hip joint, may be above and in the may be demonstrated on The in may be by The in the The disease in an protrusion of the acetabulum, so that it into the pelvis as a The of protrusion from a to four five in As the acetabulum it inward, and forward so that it may above the of the the and at and In the protrusion to the joint and, as a of the pelvis The inner of the acetabulum may be in as an As it into the pelvis, a process is the joint by the of a on the inner aspect of the acetabulum to its The of the acetabulum outward the neck of the femur as irregular In the typical is of the of the femoral This to be a since the femoral head must its This is in the of all although of the of the cartilaginous of the may from the of the It may and at other slightly a outward from the of the bony are which the femoral The acetabular with the from the the femoral head the The of in a must be As the femur the acetabulum, appears to be of its This however, is more than and is due to two the of the acetabulum, by the and the protrusion from the femoral head which at the of the As the head of the femur is the acetabulum, the the of the pelvis and The trochanter on the of the in the of the acetabular and the trochanter the The of the the femur cannot be rotated outward In the acetabulum may two and fairly large for the femoral and a for the trochanter. The of the at the of the pelvis the deformity. of the femur is its is and the on the inner of the acetabulum ossified. The stage of the disease is thus and the deformity is 1. number and on arthritis of the left In the a gonorrhoeal his left and he was to his on the He was by his and the his he a following which he in the left He was to an he four At this hospital a was to the hip for and his at the same The but the hip ankylosed. In he hospital and and for This but the of the hip At still which he of the hip was under a Orthopaedic in flexion of the left hip was to only about was and was of the to about three-quarters of an inch. was the but a was on the inner aspect of the The joint was not and were in Figure (not 2. and on arthritis of the left knee and to was to by This was by in left and hip in the which the to in left hip and lower Orthopaedic who was apparently in great in on left with In the right lower was of but on hip was held but be although of in the hip and was left on on was and his in the his from to and were of of on in Figure a from the which was the deformity of the left hip was and A was which was removed on In the was and at that a typical intrapelvic protrusion of the left acetabulum was not 1924. on The previous was The previous was of as a in the latter half of he was and was to a base he was for a condition with The that the condition was a than a He in the hospital for one and was as of was and at that hospital were as were also at from the base he was with a in the left hip which so as to This was and localized in the left It was on and on and was somewhat by At the end of one he was to be and the had but some The years a of this a of by to be by so that at time of only was in the left Orthopaedic condition and were for the left was some as well as a of all about the hip in flexion and and were and 1924 not number in the osteo-arthritis of both in the sacro-iliac and hip for the during the The appears to in the sacro-iliac and hip and down the to be on the left Orthopaedic with a and of the thighs were flexion were flexion was only both thighs were to be ankylosed. was both sacro-iliac not number in clinic in the and right the years had irregular in the and right during The was in from the both The in the the sacro-iliac was in and only by and The in the and right knee was in the had of both Orthopaedic with a was of all in both on the right and in particular to be was a of the right knee joint in were in both and of the the heads of the were fairly and typical osteo-arthritic protrusion of the of the right sacro-iliac joint, and of the left sacro-iliac joint not number in the osteo-arthritis of the The of the condition about with in both the the had been more and to be on the right apparently in the and down the the had been some in on the right the had been a Orthopaedic in both was was a present, on both was of not The of a gonorrhoeal by of the and hip 1 as of gonorrhoeal The shows a typical intrapelvic protrusion of the 2 is of This an arthritis of the hip following and an at the time of the joint due to of the with of the the was not as the it is at to that the condition an The destructive process as demonstrated by the itself in its by of the acetabulum the femoral head of the the deformity had and was demonstrated at this it is from the not shown) that the had not in the femoral but in the This case the of the disease and the deformity. The of is that of a typical intrapelvic This case has been reported. The was that the in the newly inner of the acetabulum are small and that the bone is a to that seen in in long The of was probably the The of a of as well as the and of a process in the and hip point to a with the lesions of the in and In the hip in the process as a In the review of the it is that is regarding the of the regarding its appears to be due to by various to it a disease entity, having as its a this as A of the the fact that the condition may be by process which the acetabulum and the femoral head disease in a localized of the acetabulum can the the femoral head its that this is The destructive however, must not be and must bone have seen of all the in the the only one in which the gonorrhoeal of the disease appears to have been the findings in a case as be and to are to this other has the from an It is the of orthopaedic that gonorrhoeal are and of result in The of of intrapelvic protrusion are of a and not progressive deformity. gonorrhoeal it is bony in the that in an Otto pelvis appears to be due to numerous small bone the in other Schlagenhaufer that intrapelvic protrusion of the acetabulum was in he its to the of it is that and might the its on subsequent be one the of more intrapelvic protrusion in of gonorrhoeal arthritis of the can be stated for the In this is an and the joint and result in The Otto deformity and shows only of but is, as a of the of the In all the femoral heads and the of the were still although the were A of the hip is during the stage of a This however, is usually and and not the of in intrapelvic protrusion in is is of this is that the process is and to of and the process with with in the the process the femoral head and in its and of the to the of the head must be in to the in this the in the of the head the of the deformity. It is to that in by itself to the in that it the of the femur on an the other the since are not of bone in an acetabulum, the of a inflammatory In this the not be in be and, as a and the for the of the deformity. of intrapelvic protrusion have been reported in from the process in one is to believe that intrapelvic protrusion are In the process under the acetabular in with and of the to the of the deformity. however, the is not that of The in all the is the of a deformity in a usually at a time coxitis is the of bone and the of bone in the hip to and in the bones of the pelvis, result in intrapelvic protrusion of the In disease have the of with in and of the pelvis, the bone the of the deformity. must however, that the deformity is but a of a and in disease and the of an intrapelvic protrusion is by the both of the pelvis and In the protrusion of the acetabulum is by the and of the characteristic of this disease. theory of a that the cartilaginous of the acetabulum and are into the pelvis by the of the head of the femur. In the this deformity had not been have to the protrusion to an as disease the cartilaginous of the acetabulum and in its the whole, it to two of intrapelvic (1) an probably in (2) a chronic occurring in the of in an of the hip the has the acetabular of the hip joint, the femoral head and the protrusion the is and the head of the femur and the acetabulum, is of the head and bony may result the deformity The may in and in as and disease. In this the hip lesion is but an in the deformity. of the presented of an process in the sacro-iliac joint and and in the and In the had of which by years the of the hip it to that the to the not the Otto pelvis an but arthritis of the hip must of the and of this lesion of the hip The to the of of the New York of in the
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