Abstract
Obtaining appropriate prosthetic fit in cementless total hip arthroplasty can be challenging
in cases with disparity between the femoral and metaphyseal diameters of the femur
or cases of complex deformity. One solution has been to utilize a custom femoral component
in total hip arthroplasty. The long-term results of this option with respect to femoral
morphology are limited. This cohort was analyzed to determine the survivorship, functional
results using Harris Hip Scores (HHSs), and complication rates using these implants.
Survivorship and complications were evaluated based on the proximal femoral anatomy
and severity of arthritis. The authors retrospectively reviewed 73 cases of custom
femoral implants in total hip arthroplasties by a single surgeon. The average age
of patients at index surgery was 58.06 years (range, 36.00–73.75 years). The mean
follow-up was 8.59 years (range, 0.17–20.33 years) with a minimum of 2-year follow-up
required for analysis of HHS data. There were 8 failures at a mean of 67.68 months
(range, 2.04–135 months). The reasons for revision were infection (2), osteolysis
(1), periprosthetic fracture (3), osteolysis and aseptic loosening (1), and polyethylene
wear (1). The mean preoperative HHS was 55.38 (range, 31–90). The mean follow-up HHS
was 93.10 (range, 38–100) with a mean improvement of 37.44 (p < 0.0001). Complications included infection (3), fracture (6), and dislocation (3).
Preoperative Dorr classification A (n = 44), B (n = 24), and C (n = 1) and Kellgren–Lawrence grades I (n = 0), II (n = 2), III (n = 7), and IV (n = 60) were not predictive of failure or revision (p = 0.45, p = 0.6). There was a near significant association between Dorr classification B femur
fractures requiring revision (p < 0.053). Kaplan–Meier predicted survivorship was 20.33 years with revision for any
reason as the endpoint and total overall survivorship of 81.7%. Custom cementless
femoral stems provide satisfactory survivorship and improvement in hip scores in a
variety of patients undergoing cementless total hip arthroplasty. Fracture rates are
higher in Dorr class B femurs. The level of evidence was IV.
Keywords
hip - arthroplasty - custom
