Functional and Radiographic Outcomes of Custom Acetabular Implants for Severe Acetabular Defects: A Trauma Unit Perspective.

Introduction Increasing total hip replacements means reconstructive surgeons face more complex challenges, including acetabular bone loss, repeat revisions and complex pathologies. Paprosky type 3 defects and pelvic discontinuities (PDs) need careful planning, specialised tools and a high degree of skill. Literature has yet to agree on the most optimal way to manage these challenges, with the birth of custom acetabular implants (CAIs) to treat severe acetabular defects representing a reliable solution. However, their integration into common practice is still evolving. This study evaluated clinical and radiographic outcomes of CAIs, analysing patient demographics and surgical indications associated with their use. Methods This single-centre retrospective review at Colchester General Hospital assessed acetabular reconstruction using a custom-made 3D-printed titanium implant between 2018 and 2024.  Outcome measures included implant survivorship, complications (dislocation, fracture, infection), radiographic satisfaction (assessing for loosening or migration of the implant), and clinical outcome identified through mobility postoperatively and the Oxford Hip Score.  Results Sixteen patients were enrolled in the study. Sixty-three percent (63%) achieved full weight bearing, and 94% achieved satisfactory radiographic outcomes. There was a 19% complication rate, with two infections and one dislocation. Patients chosen for the procedure had a Charlson Comorbidity Index (CCI) of 0.5 and an average age of 73, resulting in no postoperative admissions to the intensive care unit, thus displaying their capacity to withstand the surgery. Discussion CAIs are useful in challenging cases with PD and acetabular bone loss requiring only a posterior approach. 3D reconstructions aid both planning and strategising, thus avoiding future complications. CAIs are useful in these salvage cases with limited options; however, candidates chosen need to be fit enough to tolerate the surgery. Providing such a service needs support from the parent company alongside careful follow-up for at least 12 months. Overall, CAIs are advocated to treat complex acetabular defects and PDs to improve patient function and quality of life.