Custom-Made Acetabular Implants in Complex Revision Total Hip Arthroplasty: A Systematic Review (2000–2025)

Abstract

Background/Objectives: Severe acetabular bone loss, particularly Paprosky type IIIA and IIIB defects and pelvic discontinuity, represents a major challenge in revision total hip arthroplasty (rTHA). Custom-made acetabular implants offer a patient-specific reconstructive option when conventional techniques may not provide adequate fixation. This systematic review evaluated the clinical outcomes, implant survivorship, complication profile, and methodological quality of custom-made acetabular implants used in complex rTHA. Methods: A systematic literature search of PubMed, ScienceDirect, and Web of Science was performed to identify eligible studies published between January 2000 and December 2025 reporting outcomes of custom-made acetabular implants in rTHA. Thirty-six eligible clinical publications were included in the qualitative synthesis. Potentially overlapping or longitudinally related patient cohorts were identified and not treated as independent populations when interpreting outcomes. Data extraction included study design, patient and defect characteristics, implant type, follow-up duration, implant survivorship, functional outcomes, complications, and re-revision. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Results: Reported implant survivorship ranged from 72.4% to 100% across the included studies, with several series reporting survivorship above 90% at mid- to long-term follow-up. Functional outcomes generally improved following reconstruction, while aseptic loosening was relatively uncommon. Infection and instability were important causes of reoperation and implant failure. Methodological quality was variable: among the 34 non-comparative publications, MINORS scores ranged from 6 to 13 out of 16, while the two comparative publications scored 15/24 and 14/24. Considerable heterogeneity in patient populations, defect severity, implant design, follow-up duration, and outcome reporting precluded quantitative pooling. Conclusions: Custom-made acetabular implants represent a potential reconstructive option for carefully selected patients undergoing complex rTHA for severe acetabular bone loss and pelvic discontinuity. Published studies report favorable implant survivorship and improvements in functional outcomes; however, the evidence is derived predominantly from retrospective, non-comparative series and does not establish superiority over alternative reconstructive strategies. Prospective, multicenter, comparative investigations using standardized outcome definitions and longer follow-up are needed to better define long-term effectiveness.