JOA - 2026-05-20 - Journal Article
Cup-Cage and Custom Triflange Implants in Revision Total Hip Arthroplasty for Acetabular Bone Loss: A Systematic Review and Meta-Analysis.
Gwam C, Pierce T, Suhardi V, Aggarwal VK, Schwarzkopf R, Hepinstall M
Topics
Key Takeaway
After meta-regression adjustment for defect severity, cup-cage and custom triflange constructs show equivalent re-revision, PJI, instability, and aseptic loosening rates across 808 revision THAs at mean follow-up of 5.8–6.2 years.
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Summary
This meta-analysis compared cup-cage versus custom triflange reconstruction for Paprosky 2–3B acetabular defects in revision THA using 18 studies from 2015–2025. The cup-cage cohort had significantly more Paprosky 3B defects (79.2% vs 71.8%, P<0.001), necessitating meta-regression adjustment for defect severity. After adjustment, no significant differences were identified in re-revision, PJI, instability, or aseptic loosening between constructs.
Key Limitation
The underlying studies are predominantly retrospective with small cohorts, and pooling across heterogeneous implant designs, surgical techniques, and surgeon experience levels introduces unmeasured confounding that meta-regression for defect severity alone cannot fully resolve.
Original Abstract
BACKGROUND
Management of severe acetabular bone loss during revision total hip arthroplasty (rTHA) remains challenging. Cup-cage constructs and custom triflange acetabular components are commonly used, but comparative outcomes remain poorly defined.
METHODS
This meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were four electronic databases searched for studies published from 2015 to 2025 that reported outcomes of cup-cage or custom triflange reconstruction in patients who had Paprosky 2 to 3B acetabular defects. Indications for cup-cage and triflange constructs were recorded. Re-revision, periprosthetic joint infection (PJI), instability, and aseptic loosening were pooled using fixed- and random-effects models. Meta-regression was performed to adjust for acetabular defect severity.
RESULTS
There were 18 studies comprising 808 revision THAs (293 cup-cage and 515 custom triflange) included. Across both reconstruction strategies, the most common indications were aseptic loosening and conversion after periprosthetic joint infection. The weighted mean follow-up was 5.8 years for cup-cage and 6.2 years for triflange reconstructions (P = 0.071). The cup-cage cohort had a higher proportion of Paprosky 3B defects than the triflange cohort (79.2 versus 71.8%, P < 0.001). After adjustment for acetabular defect severity, no differences in re-revision rates were observed between cup-cage and triflange constructs. Likewise, there were no differences in PJI, instability, or aseptic loosening between groups.
CONCLUSIONS
Among patients undergoing rTHA with cup-cage or custom triflange reconstruction for Paprosky 2 to 3B defects, outcomes were equivalent across major failure modes after adjustment for bone loss severity. Neither construct demonstrated superior survivorship; therefore, implant selection should be individualized according to defect pattern, available resources, surgical goals, and surgeon preference rather than an expectation of differential clinical performance.