Are Customized Implants a Solution in Acetabular Revision Surgery? A Case Study
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Published:
Oct 17, 2023
Keywords:
Revision, acetabular, custom-made
Main Article Content
Abstract
We present the case of a 73-year-old patient, previously treated with two hip prosthesis revisions due to a chronic infection caused by a multidrug-resistant microorganism, who consulted after the first surgical procedure. Radiographic and computed tomography studies revealed a Paprosky type IV femoral defect and a type IIIA acetabular defect. Following clinical and laboratory monitoring, it was decided to perform acetabular reconstruction using a custom-made implant and a tumor stem. Two years later, the patient shows a favorable evolution: he is able to walk with a cane and without pain. The implant is stable and properly positioned, with no recurrent infection.
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How to Cite
Garrido Ferrer, J. F., Marco Díaz, L., Mairal Sanromán, C., Diranzo García, J., Estrems Díaz, V., Marquina Moraleda, V., & Hernández Ferrando, L. (2023). Are Customized Implants a Solution in Acetabular Revision Surgery? A Case Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 557-565. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1717
Section
Case Presentations
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References
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United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
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3. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted, tapered, modular femoral component. Bone Joint J 2015;97-B(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
4. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2013;21(10):601-2. https://doi.org/10.5435/JAAOS-21-10-601
5. Mahoney FI, Barthel D. Functional evaluation: The Barthel Index. Md State Med J 1965;14:61-5. PMID: 14258950
6. Paprosky WG, O´Rourke M, Sporer SM. The treatment of acetabular bone defects with an associated pelvic
discontinuity. Clin Orthop Relat Res 2005;(441):216-20. https://doi.org/10.1097/01.blo.0000194311.20901.f9
7. Van Eemeren A, Vanlommel J, Vandekerckhove M. Acetabular reconstruction with a custom-made triflange
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2):S211-S213. https://doi.org/10.1016/j.jcot.2020.02.006
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component in the management of extensive defects. Hip Int 2018;28(3):266-71. https://doi.org/10.5301/hipint.5000561
9. Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep 2020;13(5):e233965. https://doi.org/10.1136/bcr-2019-233965
10. Fang C, Cai H, Kuong E, Chui E, Siu YC, Ji T, et al. Surgical applications of three-dimensional printing in the pelvis and acetabulum: From models and tools to implants. Unfallchirurg 2019;122(4):278-85.
https://doi.org/10.1007/s00113-019-0626-8
11. Tack P, Victor J, Gemmel P, Annemans L. Do custom 3D-printed revision acetabular implants provide enough
value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative. Orthop Traumatol Surg Res 2021;107(1):102600. https://doi.org/10.1016/j.otsr.2020.03.012
12. Gruber MS, Jesenko M, Burghuber J, Hochreiter J, Ritschl P, Ortmaier R. Functional and radiological outcomes
after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: Shortterm results. BMC Musculoskelet Disord 2020;21(1):835. https://doi.org/10.1186/s12891-020-03851-9
13. Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Print Med 2020;6(1):23. https://doi.org/10.1186/s41205-020-00074-5
14. Kieser DC, Ailabouni R, Kieser SCJ, Wyatt MC, Armour P, Coates MH, et al. The use of an Ossis custom
3D-printed tri-flanged acetabular implant for major bone loss: Minimum 2-year follow-up. Hip Int 2018;28(6):668-
74. https://doi.org/10.1177/1120700018760817
15. Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: A systematic review of the literature. Arch Orthop Trauma Surg 2020;140(3):415-24. https://doi.org/10.1007/s00402-020-03334-5
16. Li H, Qu X, Mao Y, Dai K, Zhu Z. Custom acetabular cages offer stable fixation and improved hip scores for
revision THA with severe bone defects. Clin Orthop Relat Res 2016;474(3):731-40.
https://doi.org/10.1007/s11999-015-4587-0
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee
arthroplasty in Medicare enrollees. Clin Orthop Relat Res 2006;446:22-8. https://doi.org/10.1097/01.blo.0000214439.95268.59
3. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted, tapered, modular femoral component. Bone Joint J 2015;97-B(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
4. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2013;21(10):601-2. https://doi.org/10.5435/JAAOS-21-10-601
5. Mahoney FI, Barthel D. Functional evaluation: The Barthel Index. Md State Med J 1965;14:61-5. PMID: 14258950
6. Paprosky WG, O´Rourke M, Sporer SM. The treatment of acetabular bone defects with an associated pelvic
discontinuity. Clin Orthop Relat Res 2005;(441):216-20. https://doi.org/10.1097/01.blo.0000194311.20901.f9
7. Van Eemeren A, Vanlommel J, Vandekerckhove M. Acetabular reconstruction with a custom-made triflange
acetabular component through direct anterior approach - A case report. J Clin Orthop Trauma 2020;11(Suppl
2):S211-S213. https://doi.org/10.1016/j.jcot.2020.02.006
8. Citak M, Kochsiek L, Gehrke T, Haasper C, Suero EM, Mau H. Preliminary results of a 3D-printed acetabular
component in the management of extensive defects. Hip Int 2018;28(3):266-71. https://doi.org/10.5301/hipint.5000561
9. Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep 2020;13(5):e233965. https://doi.org/10.1136/bcr-2019-233965
10. Fang C, Cai H, Kuong E, Chui E, Siu YC, Ji T, et al. Surgical applications of three-dimensional printing in the pelvis and acetabulum: From models and tools to implants. Unfallchirurg 2019;122(4):278-85.
https://doi.org/10.1007/s00113-019-0626-8
11. Tack P, Victor J, Gemmel P, Annemans L. Do custom 3D-printed revision acetabular implants provide enough
value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative. Orthop Traumatol Surg Res 2021;107(1):102600. https://doi.org/10.1016/j.otsr.2020.03.012
12. Gruber MS, Jesenko M, Burghuber J, Hochreiter J, Ritschl P, Ortmaier R. Functional and radiological outcomes
after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: Shortterm results. BMC Musculoskelet Disord 2020;21(1):835. https://doi.org/10.1186/s12891-020-03851-9
13. Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Print Med 2020;6(1):23. https://doi.org/10.1186/s41205-020-00074-5
14. Kieser DC, Ailabouni R, Kieser SCJ, Wyatt MC, Armour P, Coates MH, et al. The use of an Ossis custom
3D-printed tri-flanged acetabular implant for major bone loss: Minimum 2-year follow-up. Hip Int 2018;28(6):668-
74. https://doi.org/10.1177/1120700018760817
15. Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: A systematic review of the literature. Arch Orthop Trauma Surg 2020;140(3):415-24. https://doi.org/10.1007/s00402-020-03334-5
16. Li H, Qu X, Mao Y, Dai K, Zhu Z. Custom acetabular cages offer stable fixation and improved hip scores for
revision THA with severe bone defects. Clin Orthop Relat Res 2016;474(3):731-40.
https://doi.org/10.1007/s11999-015-4587-0