Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty



In revision hip arthroplasty, custom-made implants are one option in patients with acetabular Paprosky III defects.


In a retrospective analysis, we identified 11 patients undergoing cup revision using a custom-made implant. The accuracy of the intended position of the implant was assessed on post-operative 3D CT and compared to the pre-operative 3D planning in terms of inclination, anteversion, and centre of rotation. In addition, the accuracy of post-operative plain radiographs for measuring implant position was evaluated in relation to the 3D CT standard.


We found a mean deviation between the planned and the final position of the custom-made acetabular implant on 3D CT of 3.6° ± 2.8° for inclination and of − 1.2° ± 7.0° for anteversion, respectively. Restoration of center of rotation succeeded with an accuracy of 0.3 mm ± 3.9 mm in the mediolateral (x) direction, − 1.1 mm ± 3.8 mm in the anteroposterior (y) direction, and 0.4 mm ± 3.2 mm in the craniocaudal (z) direction. The accuracy of the post-operative plain radiographs in measuring the position of the custom-made implant in relation to 3D CT was 1.1° ± 1.7° for implant inclination, − 2.6° ± 1.3° for anteversion and 1.3 mm ± 3.5 mm in the x-direction, and − 0.9 mm ± 3.8 mm in the z-direction for centre of rotation.


Custom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up.

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The support of Mr. S. Reuter during analysis of 3D-CT datasets is highly appreciated.

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Corresponding author

Correspondence to Markus Weber.

Ethics declarations

The investigation was approved by the local medical ethics committee (No.: 17-415-101).

Conflict of interest

TR has received research support by DePuy International, Otto Bock Foundation, Deutsche Arthose Hilfe. TR’s research group “patientindividual joint replacement” is supported by the German Ministry of Education and Research (BMBF, grant number 01EZ0915). JG got research support by MSD, Novartis, De Puy, Otto Bock Foundation. Further financial support is from De Puy, Orthotech, Ozo-zours, Fischer Fussfit, Urban & Kemmler. JW is an employee for AQ implants. All other authors declare no potential conflict of interest.

Additional information

This work was performed at Regensburg University Medical Center, Department of Orthopaedic Surgery, Bad Abbach, Germany.

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Weber, M., Witzmann, L., Wieding, J. et al. Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty. International Orthopaedics (SICOT) 43, 2235–2243 (2019).

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  • Total hip arthroplasty
  • Revision
  • Custom-made implant
  • Acetabular Paprosky III defects
  • 3D CT