Acetabular reconstruction with custom 3D-printed implants: surgical technique and report of experience

Background / Problem: Management of severe acetabular bone loss (Paprosky type IIIA/B, IV) and pelvic discontinuity presents a formidable challenge in revision total hip arthroplasty (THA). While porous metal modules are effective for moderate defects, they often suffice poorly for massive defects or discontinued anatomy, necessitating more tailored reconstructive solutions.

Objective of the Article: This study reports on a ten-year experience (2011–2021) comprising 68 cases to define the surgical indications, technical principles, and clinical outcomes of using custom 3D-printed titanium implants for complex acetabular revisions.

Key Points / Core Message: Utilizing Electron Beam Melting (EBM) technology and preoperative CT planning, the authors developed specific protocols for implant generation. The surgical technique prioritizes achieving primary uncemented press-fit fixation—specifically equatorial or craniocaudal anchorage—to ensure biological integration. The authors propose a decision-making algorithm based on the feasibility of this press-fit. Implants were consistently paired with cemented dual-mobility (DM) cups to mitigate instability, a primary complication observed (20% in the initial series). Notably, the study validates the use of these implants in septic revisions, reporting successful outcomes in one-stage exchange procedures for periprosthetic joint infection (PJI) comparable to aseptic cases. Immediate full weight-bearing was achieved in 90% of patients.

Conclusion / Implications for Practice: Custom 3D-printed implants offer a robust, viable solution for massive acetabular defects and pelvic discontinuity where standard modular options fail. Clinical success is contingent upon rigorous 3D planning, achieving press-fit stability, and the correct concomitant use of dual-mobility constructs to prevent dislocation.