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

Abstract

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. 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. 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. 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.