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Published on: April 19, 2024
Custom Pelvic Implants in Complex Total Hip Arthroplasty.
Roy F Small1, Benjamin J Koerner, Jonathan R Lynch
1From the Orthopaedics Northeast, Ortho Northeast Research Institute, Fort Wayne, IN (Small, Koerner, Lynch, Johnson).
Summary
Custom pelvic implants (CPIs) offer a reliable solution for complex hip revision surgery with severe bone loss. These patient-specific implants provide durable fixation and improved function, demonstrating high survivorship in challenging acetabular reconstructions.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Radiology
Background:
- Severe acetabular bone loss and pelvic discontinuity pose significant challenges in revision total hip arthroplasty.
- Standard reconstructive techniques may fail to achieve durable fixation or restore hip biomechanics.
Purpose of the Study:
- To review the evolution, nomenclature, indications, and design of custom pelvic implants (CPIs).
- To outline preoperative evaluation, surgical techniques, and outcomes for CPIs in acetabular reconstruction.
Main Methods:
- Review of literature on CPIs, from early designs to modern porous-coated implants.
- Discussion of CT-based modeling, implant design considerations, and surgical management of pelvic discontinuity.
- Analysis of published midterm to long-term outcomes and economic comparisons.
Main Results:
- CPIs are patient-specific, additively manufactured monoblock constructs designed for maximal fixation.
- Surgical techniques focus on construct stability and osseointegration, with effective management of pelvic discontinuity.
- Published outcomes show high implant survivorship, improved function, and low mechanical failure rates, with revisions mainly due to infection or instability.
Conclusions:
- Custom pelvic implants provide an effective and reproducible strategy for complex acetabular reconstruction.
- Appropriate patient selection, design collaboration, and surgical execution are crucial for successful CPI application.
- CPIs are cost-comparable to other advanced options, offering reliable fixation in challenging cases.
