Custom Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review

Custom acetabular components (CACs) have demonstrated promising results in revision total hip arthroplasties with substantial acetabular bone loss. However, previous systematic reviews are limited by short follow-up. The purpose of this systematic review was to report midterm outcomes of CACs in revision total hip arthroplasties.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. We searched MEDLINE, EMBASE, Cochrane Databases, and Scopus databases for English publications with a minimum 2-year follow-up. There were 14 studies that met the inclusion criteria, with 592 CACs available for rerevision and implant removal analysis and 603 available for reoperation analysis. The mean age was 63 years, the mean body mass index was 29, and 68% were women. The mean follow-up was 7 years.

The CAC rerevision rate was 19 per 1,000 person-years of follow-up (n = 84), the all-cause rerevision rate was 21 per 1,000 person-years (n = 93), and the CAC removal rate was eight per 1,000 person-years (n = 36). The most common indications for CAC rerevision included dislocation (n = 31), periprosthetic joint infection (PJI, n = 30), and CAC aseptic loosening (n = 12). The indications for CAC removal included PJI (n = 22), aseptic loosening (n = 12), and dislocation (n = 2). In addition to the 93 rerevisions, there were 37 reoperations (28 per 1,000 person-years). The mean Harris Hip Score improved from 38 to 75 at final follow-up.

In this systematic review including over 600 CACs, the rerevision rate was 19 per 1,000 person-years, but 94% of CACs were retained at a mean of 7 years of follow-up. Considering the complexity of these cases, CACs have acceptable survivorship. Dislocation and PJI contributed to the high rerevision rate, while PJI and aseptic loosening were the most common reasons for implant removal.

Level IV, Systematic Review of case series.