Survival analysis of 3D printed acetabular implants in revision total hip arthroplasty associated with severe pelvic discontinuities

Technol Health Care. 2024 Feb 7. doi: 10.3233/THC-231647. Online ahead of print.

Abstract

Background: Surgeons still face difficulties when performing aseptic acetabular revision on patients with extensive defects. Advances in three-dimensional printing technology (3DP) have afforded to the surgeons to create a patient-specific implant matching the morphology and topography of the defect.

Objective: The aim of the current research was to determine the survivorship in the treatment of acetabular bone defects with pelvic discontinuity (PD).

Methods: In order to reconstruct Paprosky type III defects with PD, twenty-three patients underwent revision total hip arthroplasty (THA) utilizing 3D-printed implants (Mobelife). The primary outcomes were the implant-associated failure rate correlated with survivorship. As secondary variables, complications and the effect of age, sex, comorbidities, history of infections and the presence of other lower limb arthroplasties on a new revision were analyzed.

Results: Patients were followed out to a mean of 67.22 ± 39.44 months (range, 0.9-127 months). Mobelife implant mean survival was 102.57 ± 9.90 months (95% CI 83.17-121.96). The cohort's implant one-year survival rate was 87%; at ten years, it dropped to 78.3%. There were four revisions: three due to periprosthetic joint infection (PJI) and one case due to aseptic loosening. Cox regression analysis did not identify any variable as predictor of failure.

Conclusion: The use of 3DP patient-specific acetabular components has shown encouraging results and it is a viable treatment option for addressing acetabular defects with combined PD in aseptic THA revision.

Keywords: 3D printing; Acetabular bone loss; Paprosky type III bone defect; patient-specific implants; pelvic discontinuity.