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

Abstract

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