Custom-Made 3D-Printed Augments and Cages: An Effective Solution for Managing Severe Acetabular Bone Loss.

Abstract

Introduction: Total hip arthroplasty (THA) is recognized as one of the most effective surgical procedures for the treatment of end-stage hip arthritis. However, the increasing number of primary THA cases has led to a corresponding rise in the frequency of revision surgeries, which are often more complex and challenging due to severe acetabular bone loss. In such cases, managing Paprosky type 3A and 3B defects requires precise implant design and advanced surgical techniques. Standard acetabular augments and anti-protrusio cages are commonly used, but they often fail to provide the necessary stability, leading to re-revision rates as high as 36% within 10 years. This case series explores the efficacy of custom-made 3D-printed acetabular augments and cages in managing severe acetabular bone loss during revision THA.

Materials and methods: This retrospective case series includes seven patients who underwent revision THA for Paprosky grade 3 acetabular bone loss between January 2023 and April 2024 at two high-volume tertiary care centers. The mean age of the patients was 45 years, with three males and four females included in the study. Pre-operative planning involved advanced imaging techniques, including 3D-computed tomography scans and custom virtual modeling, to design the acetabular components tailored to each patient's specific anatomical requirements.During the surgeries, custom-made 3D-printed titanium augments and cages were used. These implants were fabricated using in-house software, and the turnaround time from the decision to surgery was approximately 10 days. Post-operatively, the planned 3D model was superimposed on post-operative radiographs to assess implant placement accuracy. The Harris hip score at the final follow-up averaged 69.16, with no signs of implant loosening observed.

Conclusion: Custom-made 3D-printed acetabular augments and cages offer a reliable and cost-effective solution for managing severe acetabular bone loss in revision THA. Despite the small sample size and short follow-up period, the results demonstrate the potential of these custom implants to improve outcomes in complex acetabular reconstructions. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings and establish long-term efficacy.