Related Experiment Video
Updated: Sep 6, 2025
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Outcomes of primary total hip arthroplasty using 3D image-based custom stems in unselected patients: a systematic
A Nogier1,2,3, I Tourabaly2,3, S Ramos-Pascual4
1Service de Chirurgie Orthopédique, Clinique Trenel, Sainte-Colombe, France.
Insights
This systematic review found that primary total hip arthroplasty (THA) with 3D custom stems shows promising short-term results but lacks sufficient evidence for routine use. Further research is needed to standardize custom stem designs and reporting for better clinical outcomes.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Radiology
Background:
- Primary total hip arthroplasty (THA) is a common procedure for hip joint issues.
- Three-dimensional (3D) image-based custom stems offer potential for personalized implant fit.
- Limited data exists on the clinical and radiographic outcomes of these custom stems in unselected patient populations.
Purpose of the Study:
- To systematically review clinical and radiographic outcomes of primary THA using 3D image-based custom stems.
- To assess the revision and complication rates associated with these custom implants.
- To identify areas for improvement in future custom stem design and reporting.
Main Methods:
- Systematic review adhering to PRISMA guidelines, registered with PROSPERO.
- Searched MEDLINE, Embase, and Cochrane databases for relevant clinical studies.
- Included 14 studies (n=1936 hips) reporting on primary THA with 3D custom stems, excluding cases with major anatomical deformities.
Main Results:
- Considerable heterogeneity observed in custom stem characteristics (manufacturer, geometry, coating, length).
- Revision rates varied: 0-1% (short-term), 0-20% (mid-term), 4-10% (long-term).
- Post-operative Harris hip scores were generally high across all timeframes, but radiographic outcome reporting was insufficient.
Conclusions:
- Primary THA with 3D image-based custom stems demonstrates limited but promising clinical and radiographic outcomes in unselected patients.
- Excellent survival rates were noted, but evidence is insufficient to recommend routine use.
- Future studies should standardize reporting of stem design, fixation, and surgical parameters, with a proposed classification system for custom stems.
Abstract:
To report clinical and radiographic outcomes of primary THA using three-dimensional (3D) image-based custom stems. This systematic review was performed according to PRISMA guidelines and registered with PROSPERO (CRD42020216079). A search was conducted using MEDLINE, Embase and Cochrane. Clinical studies were included if they reported clinical or radiographic outcomes of primary THA using 3D image-based custom stems. Studies were excluded if specific to patients with major hip anatomical deformities, or if not written in English. Fourteen studies were eligible for inclusion (n = 1936 hips). There was considerable heterogeneity in terms of manufacturer, proximal geometry, coating and length of custom stems. Revision rates ranged from 0% to 1% in the short-term, 0% to 20% in the mid-term, and 4% to 10% in the long-term, while complication rates ranged from 3% in the short-term, 0% to 11% in the mid-term and 0% to 4% in the long-term. Post-operative Harris hip scores ranged from 95 to 96 in the short-term, 80 to 99 in the mid-term, and 87 to 94 in the long-term. Radiographic outcomes were reported in eleven studies, although none reported 3D implant sizing or positioning, nor compared planned and postoperative hip architecture. Primary THA using 3D image-based custom stems in unselected patients provides limited but promising clinical and radiographic outcomes. Despite excellent survival, the evidence available in the literature remains insufficient to recommend their routine use. Future studies should specify proximal geometry, length, fixation, material and coating, as well as management of femoral offset and anteversion. The authors propose a classification system to help distinguish between custom stem designs based primarily on their proximal geometry and length.
