BACKGROUND: The objectives of this study were to assess survivorship, functional outcomes, radiographic osseointegration, complications, and risk factors for failure in revision total hip arthroplasty (THA) with custom triflange acetabular components (CTAC) at mid-term follow-up.
METHODS: This study included 56 non-oncological patients who had advanced acetabular bone defects undergoing revision THAs using CTACs. Implant survivorship, the Oxford Hip Score (OHS), the Harris Hip Score (HHS), the University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Forgotten Joint (FJS) Score, plain radiographic evidence of osseointegration, and any complications were recorded at the most recent follow-up. The mean follow-up time was 44.8 months (range, 13.7 to 63.4).
RESULTS: Survivorship of the CTAC was 94.3% (95% confidence interval (CI): 82.6 to 98.2) with CTAC revision for aseptic loosening as the end point. In total, five CTACs were revised: three for aseptic loosening and two for prosthetic joint infections. The median OHS improved from 12 (interquartile range(IQR), 10 to 14) preoperatively to 36 (IQR, 34 to 38) at final follow-up (P < 0.001). The median HHS was 64 (IQR, 60 to 72), the median UCLA score was 6 (IQR, 5 to 7), the median WOMAC score was 34 (IQR, 40 to 26), and the median FJS was 28 (IQR, 22 to 34) at final follow-up. Radiographic osseointegration at the bone-implant interface was observed in 42 patients (75.0%). Risk factors for radiographic failure included more than four previous hip operations (P < 0.001) and greater than two-thirds of ischial osteolysis (P < 0.001).
DISCUSSION: The reconstruction of advanced acetabular bone defects with CTACs is associated with excellent component survivorship, low risk of aseptic loosening, satisfactory functional outcomes, and good radiographic evidence of osseointegration. Multiple previous hip operations and extensive ischial osteolysis were associated with increased risk of radiographic failure.
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