Silva Geeth, Lopez Djon, Sloper Philip, Wardle Nicholas
Trauma and Orthopaedics, Colchester General Hospital, Colchester, GBR.
Cureus. 2025 Jun 29;17(6):e86987. doi: 10.7759/cureus.86987. eCollection 2025 Jun.
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.
引言 全髋关节置换手术数量的增加意味着重建外科医生面临着更复杂的挑战，包括髋臼骨丢失、再次翻修以及复杂的病情。Paprosky 3型缺损和骨盆连续性中断（PDs）需要精心规划、专用工具以及高超的技术。对于应对这些挑战的最佳方法，文献中尚未达成共识，而定制髋臼植入物（CAIs）的出现为治疗严重髋臼缺损提供了一种可靠的解决方案。然而，它们融入常规医疗实践的过程仍在不断发展。本研究评估了CAIs的临床和影像学结果，分析了与其使用相关的患者人口统计学特征和手术指征。
方法 这项在科尔切斯特综合医院进行的单中心回顾性研究评估了2018年至2024年间使用定制3D打印钛植入物进行髋臼重建的情况。结果指标包括植入物存活率、并发症（脱位、骨折、感染）、影像学满意度（评估植入物的松动或移位情况）以及通过术后活动能力和牛津髋关节评分确定的临床结果。
结果 16名患者纳入本研究。63%的患者实现了完全负重，94%的患者获得了满意的影像学结果。并发症发生率为19%，其中有两例感染和一例脱位。接受该手术的患者查尔森合并症指数（CCI）为0.5，平均年龄为73岁，术后无需入住重症监护病房，这表明他们有能力承受该手术。
讨论 CAIs在处理伴有PD和髋臼骨丢失且仅需后入路的具有挑战性的病例中很有用。3D重建有助于手术规划和策略制定，从而避免未来的并发症。CAIs在这些选择有限的挽救性病例中很有用；然而，所选的患者需要身体状况良好，能够耐受手术。提供这样的服务需要母公司的支持以及至少12个月的密切随访。总体而言，提倡使用CAIs治疗复杂的髋臼缺损和PDs，以改善患者的功能和生活质量。
