Short- to mid-term outcomes of custom trabecular titanium acetabular components for severe Paprosky III defects

Revision total hip arthroplasty (rTHA) in Paprosky IIIA and IIIB acetabular defects requires advanced reconstruction strategies. This study evaluates the short- to mid-term outcomes of custom trabecular titanium acetabular components in these challenging scenarios, with a focus on a high-comorbidity cohort. A retrospective analysis was conducted on 23 patients (mean age: 73.2 years) treated between December 2019 and June 2023. Clinical and radiographic outcomes assessed included the Harris Hip Score (HHS), limb length discrepancy (LLD), restoration of the center of rotation (COR), osteointegration, complications, and reoperations. Mean follow-up was 3.8 years (range: 2.3--5.6). Patients demonstrated a marked functional improvement, with HHS increasing from 41.8 to 83.9 points (*p* < 0.001). Radiographically, significant biomechanical restoration was achieved: COR migration decreased from 4.3 cm to 1.3 cm (*p* < 0.001), LLD improved to 8.3 mm, and osteointegration was observed in 95.7% of cases at a mean of 13 months. The cohort had a high comorbidity burden. The overall complication rate was 17.4%, including two periprosthetic joint infections (8.7%) managed with debridement and suppressive antibiotic therapy, one case of persistent wound drainage, and one case of aseptic loosening pending revision. The overall reoperation rate was 8.7%. Custom trabecular titanium acetabular components were associated with improved biomechanics and function in Paprosky III defects at short- to mid-term follow-up. The notable infection rate underscores the high-risk nature of this population . While this series provides supportive evidence for its use, the small sample size and lack of a control group suggest that these findings should be interpreted as preliminary . This strategy represents a viable option for complex acetabular revisions in selected cases . • Custom trabecular titanium acetabular components achieved significant functional improvement (HHS from 41.8 to 83.9; p<0.001) and reliable biomechanical restoration in Paprosky IIIA/IIIB defects. • Radiographic osseointegration was confirmed in 95.7% of cases, with reoperation-free survival of 91.3% at a mean follow-up of 3.8 years. • In this high-risk cohort, implant fixation was maintained in cases of periprosthetic infection managed with retention, and a notable infection rate (8.7%) was observed