Abstract
The custom triflange acetabular component has been advocated for severe acetabular defects and pelvic discontinuity, cases in which a porous-coated hemisphere will not work. These are AAOS type III or IV defects, or alternatively classified as Paprosky 3B. Many have a pelvic discontinuity. A preoperative CT of the pelvis is sent to the manufacturer who generates a one to one scale 3D model of the hemipelvis. If the visualised defect cannot be treated with traditional methods then a triflanged component is created. Initial rigid fixation is obtained with screw fixation to the ilium and ischium. Subsequent bone ingrowth can provide long term fixation. The goal is to span the acetabular defect and obtain fixation to ilium and ischium with a third flange which rests on the pubis. Christie first reported on 67 hips (half with a discontinuity) with a mean follow-up of 53 months. No components were removed. There was an 8% reoperation for dislocation, 6% partial sciatic nerve palsy. Dennis reported 26 hips with a mean 54 month follow-up. Eighty-eight percent were considered successful. Taunton reported 57 cases with a pelvic discontinuity treated with a triflange at mean follow-up of 65 months. Eighty-one percent had a stable component and a healed pelvic discontinuity. The primary disadvantage of the technique is the preoperative time required to manufacture the device – typically 4–8 weeks.
