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Updated: May 23, 2026
The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
Published on: August 4, 2022
Cup-Cage and Custom Triflange Implants in Revision Total Hip Arthroplasty for Acetabular Bone Loss: A Systematic
Chukwuweike Gwam1, Todd Pierce2, Vincentius Suhardi1
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Background:
Management of severe acetabular bone loss during revision total hip arthroplasty (rTHA) remains challenging. Cup-cage constructs and custom triflange acetabular components are commonly used, but comparative outcomes remain poorly defined.
Methods:
This meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were four electronic databases searched for studies published from 2015 to 2025 that reported outcomes of cup-cage or custom triflange reconstruction in patients who had Paprosky 2 to 3B acetabular defects. Indications for cup-cage and triflange constructs were recorded. Re-revision, periprosthetic joint infection (PJI), instability, and aseptic loosening were pooled using fixed- and random-effects models. Meta-regression was performed to adjust for acetabular defect severity.
Results:
There were 18 studies comprising 808 revision THAs (293 cup-cage and 515 custom triflange) included. Across both reconstruction strategies, the most common indications were aseptic loosening and conversion after periprosthetic joint infection. The weighted mean follow-up was 5.8 years for cup-cage and 6.2 years for triflange reconstructions (P = 0.071). The cup-cage cohort had a higher proportion of Paprosky 3B defects than the triflange cohort (79.2 versus 71.8%, P < 0.001). After adjustment for acetabular defect severity, no differences in re-revision rates were observed between cup-cage and triflange constructs. Likewise, there were no differences in PJI, instability, or aseptic loosening between groups.
Conclusions:
Among patients undergoing rTHA with cup-cage or custom triflange reconstruction for Paprosky 2 to 3B defects, outcomes were equivalent across major failure modes after adjustment for bone loss severity. Neither construct demonstrated superior survivorship; therefore, implant selection should be individualized according to defect pattern, available resources, surgical goals, and surgeon preference rather than an expectation of differential clinical performance.
