Comparing Short-Term Clinical Outcomes and Survivorship of Complex Revision Total Hip Arthroplasty: Custom Triflange Acetabular Implants Vs Standard Cage Reconstruction

Background Complex revision total hip arthroplasty poses challenges in cases of severe acetabular bone loss, pelvic discontinuity, or multiple prior revision total hip arthroplasties. This study compares clinical outcomes and implant survivorship between custom triflange acetabular implants (CTAIs) and standard off-the-shelf cup-cage constructs. Methods Between 2016 and 2022, our registry was screened for consecutive patients who received either a CTAI or an off-the-shelf cup-cage construct. A retrospective review assessed patient characteristics, perioperative data, and postoperative outcomes using radiographs and follow-up notes. Primary outcomes were postoperative mortality and reoperation rates. Secondary outcomes included implant migration, bony remodeling, and patient-reported outcomes using Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOSJR). Kaplan–Meier survival analysis assessed mortality-free survival and implant survivorship. Univariate and multivariate analyses was conducted to determine associations between preoperative variables and postoperative outcomes. Results Among 787 screened patients, 18 met inclusion criteria. Fourteen (78%) had Paprofsky type 3A (28%) or 3B (50%) defects. Eleven (61%) patients received a CTAI, while 7 (39%) received standard off-the-shelf cup-cage constructs. The ΔHOOSJR scores were 37.7 ± 42.4 for off-the-shelf cup-cage constructs and 48.7 ± 30.8 for CTAI, with no significant difference ( P = .531). Two (11%) patients required revision for periprosthetic joint infection, and 4 (22%) expired. Kaplan–Meier survival analysis revealed 75.2% mortality-free survivorship and 78% implant survivorship at 4 years. Conclusions Off-the-shelf cup-cage constructs and CTAIs demonstrated comparable short-term clinical outcomes and implant survivorship in this cohort of patients undergoing complex revision THA. Implant selection may therefore be guided by patient-specific factors and surgeon preference.