JOA - 2026-05-07 - Journal Article
Custom Three-Dimensional Printed Hemipelvis Reconstructions: Encouraging Early Results for Oncologic and Non-Oncologic Cases.
Abdel MP, Owen AR, Dilger OB, Rose PS
Topics
Key Takeaway
Custom ultra-porous 3D-printed hemipelvis components achieved 100% iliac osseointegration and implant retention at mean 4-year follow-up in 7 salvage cases, with ischial flange ingrowth failure in 57% (4/7).
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Summary
This study evaluated implant survivorship, osseointegration, and functional outcomes of a novel ultra-porous custom 3D-printed hemipelvis component in 7 patients (3 chondrosarcoma, 1 osteosarcoma, 2 aseptic loosening Paprosky IIIB, 1 two-stage revision for PJI) from 2018–2023. All 7 implants remained in situ at final follow-up with confirmed iliac osseointegration on CT; ischial flange ingrowth failed in 4 of 7 cases. Dislocation occurred in 2 patients (one requiring liner revision, one managed with closed reduction), and all patients were independently ambulatory at final follow-up.
Key Limitation
Seven patients with mixed oncologic and non-oncologic indications makes it impossible to attribute outcomes to implant design versus patient selection, and the sample is far too small to define true complication or survivorship rates.
Original Abstract
BACKGROUND
Additive manufacturing allows for the creation of custom acetabular components with unique shapes, geometries, and sizes for patients who have massive bone loss. The aim of the present study was to evaluate the implant survivorship, imaging results, and clinical outcomes of custom, three-dimensional (3D) printed hemipelvis reconstructions in both the oncologic and non-oncologic setting.
METHODS
We retrospectively identified seven total hip arthroplasties (THAs) from 2018 to 2023 that utilized a novel ultra-porous, custom, 3D-printed component. Indications for surgery were chondrosarcoma in three patients, aseptic loosening of the acetabular component in two patients, osteosarcoma in one patient, and reimplantation as part of two-stage revision for infection in one patient. All revision THAs had massive acetabular bone loss (Paprosky IIIB), and all primary neoplasm resections were Enneking-Dunham type III. The mean age was 56 years, 86% were men, and the mean body mass index was 33. The mean follow-up was four years (range, one to six).
RESULTS
At final follow-up, all ultra-porous, 3D-printed constructs remained in situ. There was one patient revised to a constrained liner for dislocation, and one other reoperation occurred for infection. There was an additional dislocation treated with a closed reduction. On radiographic and computed tomography images, the proximal portion of all components were osseointegrated to the ilium with no radiolucent lines. The inferior ischial flange had ingrowth failure in four cases. At the final follow-up, all patients were ambulatory (three without any gait aids, three patients who had a cane, and one who had a walker). There was no patient who died of disease, and there were no local recurrences.
DISCUSSION
Ultra-porous, custom, 3D-printed components used for hemipelvis reconstructions in salvage cases of arthroplasty and oncologic reconstruction demonstrated promising excellent early results with all osseointegrated to the ilium, all in situ to date, and all patients independently ambulatory. Dislocation continues to be the most common complication.