Acetabular custom implants in the management of severe acetabular bone defects in revision total hip arthroplasty: a systematic review of the literature

The management of severe acetabular bone defects is a challenge in revision total hip arthroplasty (rTHA). The best surgical technique has not been established. The aim of this systematic review is to summaries and critically analyze the complications, clinical and radiological outcomes of custom acetabular implants in the management of severe bone loss in rTHA. A systematic review of the English literature was performed. Retrospective or prospective studies with at least 2 years of follow-up (FU) were included. The PRISMA flowchart and checklist were considered to edit the review. GRADE system and MINORS criteria were used to evaluate quality and risk of bias of the included studies. Rates of intra- or postoperative complications, aseptic loosening, periprosthetic joint infection, reoperations and re -revisions rates were extrapolated. Thirty-two articles were included with a type IV level of evidence. One -thousand -one -hundred and ninety-seven acetabular custom components were analyzed. The studies showed good clinical and functional outcomes. The custom-made acetabular components provided stable fixation with a survival rate of 94.2 +/- 4.7% and a mean FU of 60.5 +/- 29.7 months. The mean complications rate was 29.0 +/- 16.0%. The estimated re -operation and re -revision rates were 18.2 +/- 15.3% and 5.0 +/- 4.8%, respectively. Custom-made acetabular implants appear to be an effective treatment option in severe acetabular defects (Paprosky Type III A -B or AAOS type III -IV). In pelvic discontinuity, this reconstructive technique demonstrates a high healing potential. A high rate of complications and reoperations can be reported. Accurate pre -operative planning, design and production of custom implants are crucial steps in surgery procedure. The use of dual mobility cups could be a useful strategy to reduce the dislocation rate.