title: Outcomes of Custom Flange Acetabular Components in Revision Total Hip Arthroplasty and Predictors of Failure.
abstract: Custom triflange acetabular components (CTAC) have become more popular in the treatment of Paprosky type IIIB defects with an average survivorship of 80% at 4 years. Many studies report survivorship of CTAC, but radiographic parameters of CTAC success or failure have not been previously reported. The purpose of the study was to assess radiographic and patient factors predictive of failure in CTAC.
  
  
  
  A retrospective review of 63 patients with >24 months of follow-up was completed. Continuous and categorical variables were compared between failed vs successful CTAC using Wilcoxon rank-sum test and Fisher exact test, respectively.
  
  
  
  The failure rate of the CTAC was 13.5% over an average follow-up of 4.32 years (±2.94). Patients had a mean of 2 revisions (range, 0-11) before CTAC implantation. Compared with the contralateral hip center of rotation, the failed CTAC group tended to lateralize the hip center by a mean of 18.29 mm (±11.90 mm) compared to a mean of 9.86 mm (±11.89) in the intact group, although this did not reach statistical significance (P = .1029). The Western Ontario and McMaster Universities Osteoarthritis Index function score improved from 38.94 (±14.23) to 71.35 (±21.96) at most recent follow-up (P = .0002). The Western Ontario and MacMaster Universities Osteoarthritis Index scores were not significantly different between intact and failed CTAC groups.
  
  
  
  CTAC tends to lateralize the hip center by approximately 1 cm, and there is a trend toward nearly 2 cm of lateralization in the small subset of failed CTAC. Future efforts should focus on medializing the hip center in CTAC to improve ingrowth and survivorship.
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Barlow
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Oi
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Yuo-Yu
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Alberto V
authors.initials: AV
authors.lastname: Carli
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, New York.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Choi
authors.affiliation: Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
authors.forename: Mathias P
authors.initials: MP
authors.lastname: Bostrom
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Paprosky IIIB bone loss; custom triflange acetabular component; radiographic outcomes; revision hip arthroplasty; severe acetabular defect