Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

Abstract

Purpose Acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). Severe bone loss is not uncommon especially in periprosthetic joint infection. Surgical options, including revision shells, rings, and cages-with or without bone allograft-are affected by high complication rates and unsatisfactory clinical results. We report our mid-term results of non-flanged, custom-made acetabular components in staged rTHA. Methods We retrospectively reviewed all patients undergoing two-stage revision with acetabular custom-made implants between 2014 and 2016 at a single institution. Harris Hip Scores, Oxford Hip Scores, and Visual Analogue Scales for pain were obtained, and radiographical follow-up was performed. Complications were reported and analysed. Results We included 19 patients (19 hips) with an average follow-up of 42.3 ± 11.8 months. At the time of re-implantation, significant acetabular bone loss according to Paprosky classification (IIC, IIIA-B, and pelvic discontinuity) was detected in our patients. Clinical outcomes showed statistically significant improvement from pre-operative visit to last follow-up (p < 0.01). All custom-made implants had radiological osseointegration, and we did not find any implant complications, such as loosening or malposition. No mismatch between pre-operative planning and intra-operative findings was observed. To date, we report one septic failure managed with second staged revision, and one re-operation for recurrent THA dislocation. Conclusions Custom-made acetabular implants showed excellent clinical and radiographic mid-term outcomes with a low rate of related complications, providing implant stability on residual host bone, restoring hip biomechanics, and allowing biological osseointegration. Further long-term studies are needed to confirm preliminary results.

Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results

“…However, they did not investigate the position compared to the contralateral side. Others reported satisfying final position of the implants, inclination of the shell or osseointegration, but did not investigate offsets and COR [ 28 , 29 ]. A recently published study by Walter et al showed significant lateralisation and cranialization when CTAC was used [ 30 ].…”

Use of a new off-the-shelf 3D-printed trabecular titanium acetabular cup in Chinese patients undergoing hip revision surgery: Short- to mid-term clinical and radiological outcomes

“…There has been a steady increase in the use of porous titanium customized acetabular implants in revision THA. These implants provide an individualized fit for each patient and achieve satisfactory results, including improvement in hip joint function and good stability even with severe acetabular bone loss or pelvic discontinuity [16][17][18]. However, customized implants are not indispensable if bone loss is not severe.…”

Patient-Specific Implants for Pelvic Tumor Resections

“…As only patients treated due to malignant tumors were included in this study, this studies’ results are limited and need to be considered exclusively in this patient collective. This is especially important with a recent emerge of studies describing the use of custom-made pelvic implants and components in revision arthroplasty settings, as this patient collective comes with different demographics and functional status [ 18 , 19 , 20 ].…”