Robotic-assisted complex primary total hip arthroplasty with customized metal acetabular augment - a technical case...

Severe acetabular bone loss in complex primary total hip arthroplasty (THA) with dysplasia and post-traumatic defects poses a formidable challenge. We describe a novel technique integrating a custom-designed, 3D-printed titanium augment with open-platform robotic assistance to reconstruct a Paprosky type IIIB acetabular defect.

An elderly patient with severe dysplasia and chronic Paprosky IIIB acetabular defect underwent complex primary THA utilizing a patient-specific titanium augment and a cementless cup. Preoperative planning employed CT imaging and 3D modeling to ensure a precise defect fit and optimal cup support. An open-platform robotic system facilitated accurate reaming and component impaction according to the surgical plan.

Intraoperatively, the augment was anchored to the host bone with screws, enabling placement of the cementless cup in an optimal orientation under robotic guidance. The construct restored the hip center of rotation and provided primary stability. The procedure proceeded without intraoperative complications. Estimated blood loss and operative time were recorded. Postoperative imaging demonstrated well-fixed augment and cup with anatomically restored hip center. Operative time: 361 minutes; blood loss: 3200 mL. Early rehabilitation proceeded without incident.

This case demonstrates the feasibility of combining patient-specific implants with robotic-assisted techniques in complex primary THA. The approach supported stable reconstruction of a substantial acetabular defect and suggested potential for enhanced precision in implant positioning and favorable early postoperative trajectories. Nevertheless, due to the single-case nature and limited follow-up, findings should be interpreted cautiously, and longer-term outcomes in larger, diverse cohorts are needed to determine broader applicability and durability.