Revision hip surgery can be challenging, more so in the presence of extensive bone loss and deformity on the pelvic side. Many of these cases can be well managed with the Trabecular Metal™ Acetabular Revision System (TMARS), augments and cup cage reconstruction. However with increasing numbers of revision procedures, especially in patients following multiple revisions of the hip, there are cohorts of patients who pose very challenging reconstruction and may require a robust flanged device on the acetabular side. I have been using custom components in these situations for a good number of years now.
Each case of a challenging acetabular revision case is different. Liaising with the PMI® Patient Matched Implant team from Zimmer Biomet has been very reassuring, with excellent support from designing to manufacturing of the implant. The custom device is created by using a 3D printing of the pelvis from CT scans and constructing a bone model. These are very useful tools and help in visualization and planning fixation options of the component.
Aiming to provide a pain-free and stable construct to help with early mobilization following complex revision surgery is of utmost importance to these patients and a custom component has certainly helped me achieve this. It takes around 2 weeks, after the CT scans have been uploaded for the design proposal to arrive, and after approval of the design another 6-8 weeks for the implant to be manufactured and shipped in for surgery. The design process is very meticulous and modern, taking surgeon perspective into account as well as individual patient requirements. Regular web conferencing updates about the progress of the project are greatly beneficial. I also enjoy the reliant support in dealing with such challenging cases from my department, the anesthetist and my theater team at the hospital. It is very apt to say that ‘My team is my strength!”
The following case study shows a 70 year old patient who previously had 8 revision hip surgeries on the left and presented severe acetabular bone loss and defects. She was managed with a custom component to address the acetabular defects and I incorporated dual mobility articulation with an Arcos® Interlocking stem (with cone body) on the femoral side.