Restricted accessResearch articleFirst published online 2026-3
Custom triflange acetabular components in conjunction with dual-mobility liners for extreme acetabular bone loss in revision hip arthroplasty: the first reported case series from South Asia
The global demand for primary total hip arthroplasty (THA) and the corresponding demand for revision THA continue to rise. Revision THA in the face of severe acetabular bone loss is challenging, and the custom triflange acetabular component (CTAC) has emerged as a valuable option for the arthroplasty surgeon. Furthermore, dual mobility liners have been advocated as a promising strategy to reduce the risk of dislocation, a common complication in revision THA.
Methods:
This retrospective study of prospectively collected data comprised 15 consecutive patients who underwent revision THA with 3D-printed CTACs and dual mobility liners between January 2020 and March 2023. All patients had either Paprosky type 3B defects or pelvic discontinuity. Functional outcomes were evaluated using the modified Harris Hip Score (mHHS) and pain via the Visual Analogue Scale (VAS). Implant survival and complications are reported.
Results:
At a mean follow-up of 40 months, mean mHHS improved from 30.46 to 83.90 (p < 0.001), and VAS pain scores decreased from 7.0 to 1.9 (p < 0.001). All patients reported favourable outcomes, and no case was complicated by infection, implant loosening, component failure, or revision. Radiographs showed lateralisation of the centre of rotation by about 1 cm in one patient and Brooker class 1 heterotopic ossification in another. However, all patients demonstrated radiographically stable constructs with good osseointegration at final follow-up. Complications included 2 dislocations and 2 transient sciatic nerve palsies (13.3% each). The dislocations were addressed by closed reduction.
Conclusions:
The CTAC is a powerful tool for managing extensive acetabular bone loss in revision THA. Our findings demonstrate promising outcomes with significant functional improvement, pain reduction, and implant stability.
ShichmanIAskewNHabibiA, et al. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2040–2060. Arthroplast Today2023; 21: 101152.
2.
HaynesJAStamboughJBSassoonAA, et al. Contemporary surgical indications and referral trends in revision total hip arthroplasty: a 10-year review. J Arthroplasty2016; 31: 622–625.
3.
HintonZWWuCJRyanSP, et al. Current trends in revision hip arthroplasty: indications and types of components revised. J Arthroplasty2022; 37(Suppl): S611–S615.
4.
ShethNPNelsonCLSpringerBD, et al. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg2013; 21: 128–139.
5.
PaproskyWGPeronaPGLawrenceJM.Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty1994; 9: 33–44.
6.
TelleriaJJGeeAO.Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res2013; 471: 3725–3730.
7.
SculcoPKWrightTMalahiasMA, et al. The diagnosis and treatment of acetabular bone loss in revision hip arthroplasty: an international consensus symposium. HSS J2022; 18: 8–41.
8.
AbdelMPTrousdaleRTBerryDJ.Pelvic discontinuity associated with total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg2017; 25: 330–338.
9.
GoodmanGPEnghCAJr.The custom triflange cup: build it and they will come. Bone Joint J2016; 98(Suppl. A): 68–72.
10.
Scharff-BaauwMVan HooffMLVan HellemondtGG, et al. Good results at 2-year follow-up of a custom-made triflange acetabular component for large acetabular defects and pelvic discontinuity: a prospective case series of 50 hips. Acta Orthop2021; 92: 297–303.
11.
MynckeIvan SchaikDScheerlinckT.Custom-made triflanged acetabular components in the treatment of major acetabular defects. Short-term results and clinical experience. Acta Orthop Belg2017; 83: 341–350.
12.
SchreursBWBolderSBGardeniersJW, et al. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup: a 15- to 20-year follow-up. J Bone Joint Surg Br2004; 86: 492–497.
13.
WhaleyALBerryDJHarmsenWS.Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am2001; 83: 1352–1357.
14.
AmenabarTRahmanWAHetaimishBM, et al. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res2016; 474: 408–414.
15.
SalehKJJaroszynskiGWoodgateI, et al. Revision total hip arthroplasty with the use of structural acetabular allograft and reconstruction ring: a case series with a 10-year average follow-up. J Arthroplasty2000; 15: 951–958.
16.
SchreursBWTe StroetMARijnenWH, et al. Acetabular re-revision with impaction bone grafting and a cemented polyethylene cup: a biological option for successive reconstructions. Hip Int2015; 25: 44–49.
17.
JenkinsDROdlandANSierraRJ, et al. Minimum five-year outcomes with porous tantalum acetabular cup and augment construct in complex revision total hip arthroplasty. J Bone Joint Surg Am2017; 99: e49.
18.
ArgyropoulouESakellariouEGalanisA, et al. Porous tantalum acetabular cups in primary and revision total hip arthroplasty: what has been the experience so far? A systematic literature review. Biomedicines2024; 12: 959.
19.
WyattMC.Custom 3D-printed acetabular implants in hip surgery: innovative breakthrough or expensive bespoke upgrade?Hip Int2015; 25: 375–379.
20.
GoriainovVKingLJOreffoRO, et al. Custom 3D-printed triflange implants for treatment of severe acetabular defects, with and without pelvic discontinuity: early results of our first 19 consecutive cases. JB JS Open Access2021; 6: e21.00057.
21.
De MartinoIStrigelliVCacciolaG, et al. Survivorship and clinical outcomes of custom triflange acetabular components in revision total hip arthroplasty: a systematic review. J Arthroplasty2019; 34: 2511–2518.
22.
GladnickBPFehringKAOdumSM, et al. Midterm survivorship after revision total hip arthroplasty with a custom triflange acetabular component. J Arthroplasty2018; 33: 500–504.
23.
TikhilovRMDzhavadovAAKovalenkoAN, et al. Standard versus custom-made acetabular implants in revision total hip arthroplasty. J Arthroplasty2022; 37: 119–125.
24.
BarlowBTOiKKLeeYY, et al. Outcomes of custom flange acetabular components in revision total hip arthroplasty and predictors of failure. J Arthroplasty2016; 31: 1057–1064.
OngKLLauESuggsJ, et al. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res2010; 468: 3070–3076.
27.
KenneyCDickSLeaJ, et al. A systematic review of the causes of failure of revision total hip arthroplasty. J Orthop2019; 16: 393–395.
28.
ButtaroMACombaFPussoR, et al. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res2008; 466: 2482–2490.
29.
PaproskyWGSporerSSMurphyBP.Addressing severe bone deficiency: what a cage will not do. J Arthroplasty2007; 22(Suppl. 1): 111–115.
30.
García-ReyEFernández-FernándezRDuránD, et al. Reconstruction of the rotation center of the hip after oblong cups in revision total hip arthroplasty. J Orthop Traumatol2013; 14: 39–49.
31.
MancinoFCacciolaGDi MatteoV, et al. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia)2020; 12(Suppl. 1): 8655.
32.
EdwardsPKQueenRMButlerRJ, et al. Are range of motion measurements needed when calculating the Harris hip score?J Arthroplasty2016; 31: 815–819.
33.
DeBoerDKChristieMJBrinsonMF, et al. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am2007; 89: 835–840.
34.
BroekhuisDTordoirRVallingaZ, et al. Custom triflange acetabular components for large acetabular defect reconstruction in revision total hip arthroplasty: a systematic review and meta-analysis on 1218 patients. EFORT Open Rev2023; 8: 522–531.
35.
ChristieMCDeBoerDKMorrisonJC, et al. Bridging massive acetabular defects with the triflange cup: 10- to 28-year results. J Arthroplasty2023; 38: 2423–2428.
36.
TauntonMJFehringTKEdwardsP, et al. Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res2012; 470: 428–434.
37.
WintherSSPetersenMYilmazM, et al. Custom-made triflanged implants in reconstruction of severe acetabular bone loss with pelvic discontinuity after total hip arthroplasty consecutive cohort study: two to 11 years of follow-up. Bone Jt Open2022; 3: 867–876.
38.
FaldiniCStefaniniNFengaD, et al. How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options. J Orthop Traumatol2018; 19: 17.
39.
CarterAHSheehanECMortazaviSJ, et al. Revision for recurrent instability: what are the predictors of failure?J Arthroplasty2011; 26(Suppl.): 46–52.
40.
CharissouxJLAsloumYMarcheixPS.Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res2014; 100(Suppl.): S25–S34.
