Genuine experience in the use of individual 3D implants in complex revision arthroplasty of large joints

Genuine experience in the use of individual 3D implants in complex revision arthroplasty of large joints | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Genuine experience in the use of individual 3D implants in complex revision arthroplasty of large joints Georgiy Aleksandrovich Airapetov, Ivan Aleksandrovich Dmitrov, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9463987/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Nowadays, large joint replacement surgery has become a routine procedure in modern surgery, essential for every trauma and orthopedic department. Every year, more and more patients are born worldwide who require this procedure. Consequently, the number of revision joint replacements is increasing annually. With each revision, the amount of bone tissue in the joint area diminishes. Commercially manufactured augments, cones, and sleeves are not always sufficient to address significant bone loss. Therefore, to improve treatment outcomes, patients with extensive bone defects require custom-made implants tailored to their joint anatomy. The aim The aim of this work is to improve the treatment outcomes of patients with extensive bone defects after large joint arthroplasty by analyzing and determining the optimal approach to preoperative planning, surgical intervention and the postoperative period using personalized 3D implants. Materials and Methods We present our experience treating 37 patients with extensive bone defects who required the fabrication and installation of personalized 3D implants for Hip, Knee and Shoulder joints. Functional outcomes were assessed using joint-specific questionnaires. Results As part of the 6-month follow-up the median HHS value was 71 points, the median KSS value was 79 points, which corresponds to good function of the operated knee joint. The OSS score in the case of glenoid articular surface replacement with a 3D implant was 40 points, but in the case of proximal humerus replacement, the functional score was 32 points, which primarily emphasizes the difficulty in restoring adequate function in post-traumatic arthrosis with a significant and long-term bone mass deficiency. Conclusion The use of individual 3D printed trabecular titanium implants is an effective treatment method for patients with extensive Paprosky 3B type bone defects in revision hip arthroplasty and AORI type III in revision knee arthroplasty, providing satisfactory functional results. The technology for 3D printing custom implants continues to evolve, and accumulating clinical experience allows for refinement of surgical techniques, reduction of operating time, and improved treatment outcomes. Despite the high cost of custom-made implants, the cost-effectiveness of this approach can be justified by a reduced rate of revision surgery, shorter operative time, and improved functional outcomes. Further studies with larger sample sizes, control groups, and long-term follow-up are needed to definitively evaluate the efficacy and durability of custom-made 3D-printed implants in revision arthroplasty of large joints. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Currently, large joint replacement has become a routine procedure in modern surgery, essential for any traumatology or orthopedic department. The number of patients requiring this procedure increases annually worldwide. Consequently, the number of revision joint replacements also tends to increase annually. The most common reasons for revision procedures are instability of the endoprosthesis components, both aseptic and infectious [ 1 – 3 ]. Furthermore, revision surgery can be performed multiple times on the same patient. With each revision procedure, the amount of bone tissue in the joint area decreases, requiring a greater variety of options to fill bone defects. Commercially available augments, cones, and sleeves are not always sufficient to address significant bone loss. Therefore, to improve treatment outcomes, patients with extensive bone defects require custom-made implants tailored to their joint anatomy. In 1984, thanks to the work of the American engineer Charles W. Hull, 3D printing technology was invented and patented. While primarily used in the industrial sector, this rapidly developing method also attracted attention in medical science [ 4 , 5 ]. Particular interest began to emerge in the field of custom-made implants, which facilitated the task of the operating surgeon and provided a way out of a difficult situation for the patient. Today, the technology for creating and using custom 3D implants is actively used in all areas of orthopedics, from maxillofacial surgery to endoprosthetics of small joints of the hand [ 6 , 7 ]. In the Orthopedics Department of Moscow Clinical Hospital No. 31, the first patient with an extensive acetabular defect underwent surgery with a custom-made 3D implant in 2017 (Figs. 1 , 2 ). In this clinical case, the acetabular defect arose due to instability of the acetabular component of the hip joint, which could not be compensated for with standard revision components. This clinical case is also noteworthy in that nine years after the installation of the custom 3D acetabular component, the patient developed recurrent dislocations of the prosthetic head (Fig. 3 A). We resolved this complication by removing the cemented acetabular component from the 3D implant and installing a dual mobility system (Fig. 3 B). By 2025, 37 of 281 revision hip replacements using 3D technology were required. This research paper presents the treatment outcomes for patients using custom-made hip replacement components, as well as the approach and design principles for 3D implants. The aim The aim of this study is to improve treatment outcomes for patients with extensive bone defects after large joint replacement by analyzing and determining the optimal approach to preoperative planning, surgical intervention, and the postoperative period using personalized 3D implants. Materials and Methods We present our experience treating 37 patients with extensive bone defects who required the fabrication and installation of custom-made 3D implants. This study was conducted at the Department of Traumatology and Orthopedics, Patrice Lumumba Peoples' Friendship University of Russia, and the Orthopedics Department of the G.M. Savelyeva Clinical Hospital No. 31, Moscow Health Department. The Sample structure From July 1, 2025, to March 1, 2026, 281 revision procedures were performed. The percentage distribution of revision hip, knee, and shoulder arthroplasty procedures during the study period was 149 (53%), 119 (42%), and 13 (5%), respectively. We clearly differentiated the reasons for the procedures. In 96 (34%) cases, revision was due to aseptic component instability, while in 185 (66%) cases, revision was performed as part of the second stage of revision arthroplasty for periprosthetic infection. The total number of procedures using 3D custom-made implants was 37 (13.2%). In terms of gender, 100% of patients were women, with an average age of 68 ± 7,4 years (min – 44; max – 82). The study group included 37 patients, 27 of whom had an articulating spacer in place at the time of hospitalization for the treatment of deep periprosthetic joint infections of the hip (13 cases), knee (11 cases), and shoulder (3 cases). Nine patients in the sample had bone defects associated with aseptic loosening of the acetabular component of the hip joint (HJ) (Fig. 4 ). In one clinical case of knee arthroplasty with a endoprosthesis, osteolysis of the distal femur was observed, followed by loosening of the femoral component, secondary to an existing peri-implant fracture. Radiographic assessment All patients underwent a standard preoperative examination protocol, which included mandatory radiographs and computed tomography of the affected joint. Bone loss was assessed using the generally accepted Paprosky classification for hip joint defects and the AORI classification for knee joint defects. Given that there is currently no standardized classification for shoulder joint defects in revision surgery [ 8 , 9 ], we used the G. Kocsis classification, proposed in 2016, to assess shoulder defects [ 10 ]. Postoperatively and during outpatient follow-up, all patients underwent follow-up radiographs of the operated joint. Functional Outcome Assessment Functional outcomes were assessed during follow-up consultations with patients using well-established scales: the Harris Hip Score (HHS) for the hip joint, the Knee Society Score (KSS) for the knee joint, and the Oxford Shoulder Score (OSS) for the shoulder joint [ 11 , 12 ]. Statistical Analysis The results of qualitative indicators are presented as absolute numbers (n) with percentage calculations. Normally distributed quantitative indicators were described by means and standard deviations (SD). For quantitative indicators whose distributions differed from normal, the median and the values ​​of the 1st and 3rd quartiles [Q1;Q3] were calculated. Patients' electronic medical records were reviewed in the Unified Information and Analytical System (EMIAS) in accordance with their consent to the processing of personal data. Radiographs and CT scans were reviewed and analyzed using RadiAnt DICOM viewer 2025.2 software. Results A review of 37 electronic patient records from the sample revealed that, regardless of whether the infectious or aseptic process had been resolved, massive defects uncompensated by local tissues and standardized augments were observed in the acetabulum in all cases of revision hip surgery. In contrast, standard revision devices, such as the Wagner stem with distal fixation, were successfully installed in all cases of femoral defects. The observed bone loss in the acetabular roof and columns, combined with protrusion, corresponds to a type 3B defect according to the Paprosky classification. In 11 cases of knee revision, extensive AORI type III defects of the proximal tibia were observed in 9 patients (82%). Notably, in all cases, the reason for revision was periprosthetic infection, which was treated with an articulating spacer. A single case of aseptic loosening of the femoral component of a knee replacement was observed in a patient with a peri-implant fracture of the distal femur. We believe that the combination of these factors should be considered a vicious cycle, in which unstable fixation of the revision component stem at the fracture site leads to loosening, which in turn contributes to endosteal bone loss and prevents fracture consolidation. In this case, this effect resulted in the formation of an extended femoral defect—AORI type III. In the case of using 3D technology in revision shoulder arthroplasty, an important feature was the presence of anterior instability of the articulating spacer of the shoulder joint. This factor necessitated the use of a 3D component to restore humeral length and create additional shoulder joint volume to achieve satisfactory deltoid muscle function. All patients, upon verification of extensive bone defects, underwent 3D planning of custom implants based on CT scans in collaboration with engineers involved in the production of these medical devices (Fig. 5 ). The average time from initial presentation to hospitalization for patients in the study group was 3.5 months. Within the specified timeframe, a CT scan of the affected joint was sent by an orthopedic traumatologist to the manufacturer, detailing the proposed surgical procedure. Throughout the 3D modeling and component printing process, active communication was maintained between the company's engineer and the attending physician. This collaboration resulted in the creation of a standardized, customized kit for our clinic, including a 3D component required for intraoperative testing prior to primary implant placement, a personalized 3D component made of trabecular metal (titanium alloy), and a personalized instrument for its installation. The kit must include detailed implantation instructions and patient information, including the patient's last name, first name, patronymic, and the joint being operated on (Fig. 6 ). The test and primary components, as well as the guide instruments, are sterilized 24 hours before the revision procedure. The average surgical duration in the study group was 2.8 hours for hip revision and 2.4 hours for knee revision. Surgeries on the shoulder lasted 2.5 hours. In 2017, the average surgical time for revision hip arthroplasty was 3.5 hours. In addition to targeted treatment of the compromised joint, this time includes surgical access, removal of the implants, treatment of the articulating portion of the endoprosthesis, copious irrigation, and layered wound closure (Table 1 .). Table 1 Correlation of the volume of bone mass deficiency with the time of implant production and surgical intervention Patient (gender, age) Localization of the defect Volume of bone deficiency Name of 3D implant Functional result Operation time (hour) Planning timeframe (months) Hip joint Female, 44 years old Acetabulum Paprosky 3B CTAC - Custom Triflange Acetabular Component HHS 76 3.3 4.5 Female, 59 years old Acetabulum Paprosky 3B CTAC HHS 73 3.5 6.5 Female, 60 years old Acetabulum Paprosky 3B CTAC + modular individual augment HHS 7 1 2.6 3.5 Female, 65 years old Acetabulum Paprosky 3B CTAC HHS 6 7 3.1 3 Female, 66 years old Acetabulum Paprosky 3B CTAC + modular individual augment HHS 7 3 2.4 3.5 Female, 68 years old Acetabulum Paprosky 3B CTAC HHS 7 2 2.8 2.5 Female, 68 years old Acetabulum Paprosky 3B CTAC + modular individual augment HHS 73 2.7 3 Female, 70 years old Acetabulum Paprosky 3B CTAC HHS 73 3.1 3 Female, 74 years old Acetabulum Paprosky 3B CTAC HHS 70 3.3 5 Female, 76 years old Acetabulum Paprosky 3B CTAC HHS 70 2.2 3 Female, 78 years old Acetabulum Paprosky 3B CTAC HHS 71 2.4 3 Female, 79 years old Acetabulum Paprosky 3B CTAC+ modular individual augment HHS 71 2.6 2.5 Female, 82 Acetabulum Paprosky 3B CTAC HHS 69 2.4 3.5 Knee joint Female, 63 years Tibial Plateau AORI III 3 D Augment of plateau KSS 80 2.2 3 Female, 66 years old Distal Femur AORI III Modular individual augment of distal femur KSS 82 2.2 3 Female, 66 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 84 2.1 3.5 Female, 68 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 78 2.5 4 Female, 68 years old Distal Femur AORI III Modular individual augment of distal femur KSS 79 2.0 3.5 Female, 70 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 74 2.4 4 Female, 70 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 79 2.6 3.5 Female, 70 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 77 2.7 4 Female, 70 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 76 2.9 3.5 Female, 75 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 80 2.9 4.5 Female, 75 years old Tibial Plateau AORI III 3 D Augment of plateau KSS 83 2.8 3 Shoulder joint Female, 62 Humerus Proximal third of the bone 3D Augment of the proximal third of the bone OSS 32 2.5 3.5 Female, 70 Glenoid Cocsis III 3D Augment of the neck and glenoid of the scapula OSS 40 2.5 3 The early postoperative period was uneventful in all clinical observations. Patients underwent a standardized series of examinations, including control radiography of the joint, ultrasound examination of the deep veins of the lower extremities, and electrocardiogram monitoring. Medication therapy included broad-spectrum antibiotic prophylaxis, thromboprophylaxis with indirect anticoagulants, and pain management with narcotic and non-narcotic agents. The average hospital stay in the postoperative period was 8.7 days. In the late postoperative period, all patients underwent outpatient follow-up radiographs of the operated joints at intervals of 6 weeks, 3 months, 6 months, and 12 months. In all clinical cases, implant placement was assessed as correct, consistent with the initial positioning, with no signs of osteolysis in the peri-implant area. As part of the 6-month follow-up of the sample of patients, a questionnaire was administered using the scales mentioned in the study methods. The median HHS value was 71 [67; 73] points, which corresponds to normal hip joint function. The median KSS value was 79 [76; 84] points, which corresponds to good function of the operated knee joint. The OSS score in the case of glenoid articular surface replacement with a 3D implant was 40 points, but in the case of proximal humerus replacement, the functional score was 32 points, which primarily emphasizes the difficulty in restoring adequate function in post-traumatic arthrosis with a significant and long-term bone mass deficiency. Discussion This experience using custom-made 3D implants in revision arthroplasty of large joints demonstrates the effectiveness of this technology in treating patients with extensive bone defects. The results obtained are consistent with current global data and confirm the feasibility of using personalized implants in the most complex clinical situations. Since our first experience with custom-made implants, 3D modeling technology has undergone significant changes. These changes primarily affect the metal structure preparation process itself: complete continuity and collaboration between the surgeon and engineer during the preparatory stage, the transition from monolithic to modular structures, the creation of detailed instructions specifying the size and direction of fixation screws, and the creation of plastic mock-ups, which significantly facilitate preoperative preparation. These changes now facilitate the compensation of complex defects with full understanding and control of the surgical procedure (Figs. 7 and 8 ). The functional results obtained in our study are comparable to those of leading centers worldwide. The mean HHS of 71,5 points corresponds to normal hip function and correlates with the results of the study by Fang et al., where HHS improved from 47.8 to 86.4 points at a mean follow-up of 41.5 months [ 13 ]. Kong et al. reported an improvement in HHS from 33.5 to 86.1 points using a combination of custom-made 3D-printed titanium augments with tantalum cups at a mean follow-up of 4.7 years. The KSS of 79.7 points in our series also demonstrates good knee function, which is consistent with the data of Cherny et al., who noted a significant improvement in functional indicators with the use of custom cones in revision knee arthroplasty [ 14 , 15 ]. The average time from initial presentation to hospitalization of 3.5 months in our practice is acceptable given the need for careful planning and fabrication of custom-made components. Giachino et al. demonstrated that the use of 3D-printed models for preoperative planning for type 3 Paprosky defects resulted in a shorter operative time (101.8 min vs. 146.1 min), a reduced rate of intraoperative complications (19% vs. 62.5%), and significant cost savings (a difference of €4,183) [ 16 ]. Dos Santos-Vaquinhas et al. also confirmed that preoperative planning using 3D models reduced surgical time and improved functional outcomes [ 17 ]. The average surgical time (2.8 hours for hip, 2.4 hours for knee, and 2.5 hours for shoulder) is acceptable for revision procedures of this complexity, and the reduction in the time required for these procedures compared to those performed in 2017 (3.5 hours) indicates progress and improvement in surgical technique. The absence of intraoperative interventions and a smooth early postoperative period in all cases indicate good preparation and adequate surgical planning. The absence of signs of osteolysis and implant retention in follow-up radiographs in the long-term period is consistent with the data of a systematic review by Almeida et al., which showed a survival rate of 95.52% for highly porous 3D-printed titanium acetabular cups with a mean follow-up of 3.8 years [ 18 ]. Di Laura et al. A 100% survival rate of individual 3D-printed implants for Paprosky 3B defects with foci of osseointegration was shown in 92% of patients after 12 months [ 19 ]. In a previously demonstrated clinical case of hip joint endoprosthesis dislocations 9 years after installation of a custom 3D implant, we attribute this to an extensive bone defect in the proximal femur, and therefore, a disruption of the abductor mechanism. The hip abductors (the gluteus medius and minimus) play a critical role in maintaining endoprosthesis stability. Computer modeling shows that the gluteus medius provides approximately 48.3% of the resistance during hip flexion, preventing anterior dislocation. Abductor insufficiency disrupts the dynamic stabilization of the endoprosthesis head in the acetabulum, significantly increasing the risk of dislocation [ 20 ]. With severe insufficiency or complete absence of the abductor mechanism, the incidence of dislocations increases sharply. Studies show that a compromised abductor apparatus increases the risk of dislocation with an odds ratio of 43.1 (95% CI: 3.18–586.3)—it is the most significant independent risk factor [ 21 ]. The prioritization of dual-mobility systems for proximal femoral defects and the placement of 3D components is a valid strategy. Canetti et al. demonstrated that the use of dual-mobility systems in combination with a proximal femoral endoprosthesis limits the risk of dislocation to 7.5% with a dislocation-free survival rate of 94% at 1 year, which is significantly better than the results obtained with larger femoral heads in other studies [ 22 ]. Hitz et al. demonstrated that the use of a dual-mobility system cemented into a tantalum cup in large bone defects reduces the risk of dislocation without increasing the risk of mechanical complications, with a dislocation-free survival rate of 96% at 5 years [ 23 ]. The expansion of indications for the use of dual-mobility systems in revision arthroplasty is supported by multiple studies. Unter Ecker et al. reported dislocation-free survival of 96% at 5 years and 82% at 9 years when using dual-mobility systems in complex revision cases with massive bone and soft tissue loss [ 24 ]. Ameztoy Gallego et al. demonstrated a dual-mobility system survival rate of 82.4% at 7 years in patients with a high risk of instability, with a dislocation rate of only 2.1% [ 25 ]. Khatod et al. confirmed in a large cohort study that revision arthroplasty using dual mobility systems has the lowest risk of revision and dislocation compared to other types of designs [ 26 ]. Limitations of our study include a relatively small sample size (37 patients), the lack of a control group, and a relatively short follow-up period (6 months for functional evaluation). Furthermore, all patients in our series were women, which may limit the generalizability of the results. A systematic review by Chiarlone et al. found that the average reoperation rate for custom-made acetabular components was 19.3%, while the re-revision rate was 5.2% with a mean follow-up of 58.6 months, highlighting the need for long-term follow-up of our patients [ 27 ]. Conclusion The presented experience with the use of custom-made 3D-printed implants in revision arthroplasty of large joints demonstrates the evolution of technology and surgical technique from 2017 to 2025. The annual increase in primary endoprosthetics naturally leads to an increase in revision procedures. With each subsequent revision, bone loss in the same patient progressively worsens, leading to a growing need for customized 3D-printed solutions. Accumulated clinical experience has enabled the optimization of surgical techniques, resulting in a reduction in surgical time from 3.5 hours for the first procedure in 2017 to 2.8 hours today. The transition from monolithic to modular 3D-printed structures represents a significant technological advancement, providing greater flexibility in intraoperative implant placement. Modular systems allow the surgeon to perform more precise adjustments to anteversion, offset, and limb length, which is especially important for extensive bone defects. The occurrence of endoprosthesis dislocations, even late after the initial placement of a custom 3D implant, highlights the importance of long-term patient follow-up and the need for additional strategies to prevent dislocations. The successful resolution of recurrent dislocations by installing a dual mobility system is consistent with current literature data demonstrating the high efficacy of this technology in revision arthroplasty. The use of individual 3D printed trabecular titanium implants is an effective treatment method for patients with extensive Paprosky 3B type bone defects in revision hip arthroplasty and AORI type III in revision knee arthroplasty, providing satisfactory functional results (HHS 71 [67;73] points, KSS 79 [76;84] points) with an average follow-up period of 6 months. The technology for 3D printing custom implants continues to evolve, and accumulating clinical experience allows for refinement of surgical techniques, reduction of operating time, and improved treatment outcomes. The transition to modular designs and the prioritization of dual-mobility systems for patients with a high risk of postoperative dislocation represent a logical evolution in the treatment approach for patients with extensive bone defects. However, continued long-term patient follow-up is necessary to definitively assess the efficacy and durability of these technologies, especially given that most published studies have an average follow-up period of 3 to 5 years. Despite the high cost of custom-made implants, the cost-effectiveness of this approach can be justified by a reduced rate of revision surgery, shorter operative time, and improved functional outcomes. Further studies with larger sample sizes, control groups, and long-term follow-up are needed to definitively evaluate the efficacy and durability of custom-made 3D-printed implants in revision arthroplasty of large joints. Declarations Abbreviations: Not applicable. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki. The first dataset used in the study was approved by the Department of Traumatology and Orthopedics at Peoples' Friendship University of Russia named after Patrice Lumumba. All participants provided written informed consent for use of their data prior to participation. For the second dataset used in the study, ethical approval was not required as confirmed by the Hospital named after Academician G.M. Savelieva ethics committee, since the radiography data were anonymized and collected during routine clinical care. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Data availability: The radiography and photo dataset analysed during the current study are available from the corresponding author on reasonable request. Funding: The authors declare that the research did not receive any funding Authors' contributions: I.D.,K.D.,G.A., A.P. gave information about clinical cases V.C.,D.S., V.N., prepared figures, found references A.A., I.D. wrote the main manuscript text Acknowledgements: Not applicable. References Tikhilov R.M. 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The Use of Highly Porous 3-D-Printed Titanium Acetabular Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis / Almeida P.R., Macpherson G.J., Simpson P., Gaston P., Clement N.D. // Journal of clinical medicine – 2025. – Т. 14 – № 3. Laura A. Di Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results / Laura A. Di, Henckel J., Hart A. // JB & JS open access – 2023. – Т. 8 – № 2. Yang H. Hip Stability After Total Hip Arthroplasty: Quantifying Capsule and Passive Muscle Contributions / Yang H., Colone K., Haas B., Myers C.A., Rullkoetter P.J., Clary C.W. // Journal of orthopaedic research : official publication of the Orthopaedic Research Society – 2025. – Т. 43 – № 10 – С.1826–1839. Huten D. Risk factors for dislocation after revision total hip arthroplasty with a dual-mobility cup. Matched case-control study (16 cases vs. 48 controls) / Huten D., Fournier Y., Gicquel T., Bertho P., Basselot F., Hamadouche M. // Orthopaedics and Traumatology: Surgery and Research – 2019. – Т. 105 – № 7 – С.1303–1309. Canetti R. Dual mobility cups associated with proximal femoral replacement in nontumoral indications: Results and complications / Canetti R., Malatray M., Pibarot V., Wegrzyn J. // Orthopaedics and Traumatology: Surgery and Research – 2022. – Т. 108 – № 2. Hitz O. Use of dual mobility cup cemented into a tantalum acetabular shell for hip revision with large bone loss can decrease dislocation risk without increasing the risk of mechanical failure / Hitz O., Baron M. Le, Jacquet C., Argenson J.N., Parratte S., Ollivier M., Flecher X. // Orthopaedics and Traumatology: Surgery and Research – 2024. – Т. 110 – № 2. Unter Ecker N. What Is the Dislocation and Revision Rate of Dual-mobility Cups Used in Complex Revision THAs? / Unter Ecker N., Kocaoǧlu H., Zahar A., Haasper C., Gehrke T., Citak M. // Clinical orthopaedics and related research – 2021. – Т. 479 – № 2 – С.280–285. Ameztoy Gallego J. Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability / Ameztoy Gallego J., Cruz Pardos A., Gomez Luque J., Cuadrado Rubio L.E., Fernández Fernández R. // International orthopaedics – 2023. – Т. 47 – № 7 – С.1757–1764. Khatod M. Dual-Mobility Articulations in Revision Total Hip Arthroplasty: A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations / Khatod M., Chan P.H., Prentice H.A., Fasig B.H., Paxton E.W., Reddy N.C., Kelly M.P. // The Journal of bone and joint surgery. American volume – 2024. – Т. 106 – № 24 – С.2313–2321. Chiarlone F. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature / Chiarlone F., Zanirato A., Cavagnaro L., Alessio-Mazzola M., Felli L., Burastero G. // Archives of orthopaedic and trauma surgery – 2020. – Т. 140 – № 3 – С.415–424. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9463987","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627907793,"identity":"cc39777e-96b9-4530-9397-c8ce81af7425","order_by":0,"name":"Georgiy Aleksandrovich Airapetov","email":"","orcid":"","institution":"RUDN University","correspondingAuthor":false,"prefix":"","firstName":"Georgiy","middleName":"Aleksandrovich","lastName":"Airapetov","suffix":""},{"id":627907794,"identity":"822f3d00-042f-47fe-81f9-56d3adfa2d46","order_by":1,"name":"Ivan Aleksandrovich Dmitrov","email":"","orcid":"","institution":"Department of Orthopedics of the Moscow Clinical Hospital No. 31 named after Academician G.M. Savelyeva","correspondingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"Aleksandrovich","lastName":"Dmitrov","suffix":""},{"id":627907795,"identity":"b8eff01e-7cf0-45a4-a242-26decbd89810","order_by":2,"name":"Aleksey Petrovich Prizov","email":"","orcid":"","institution":"RUDN University","correspondingAuthor":false,"prefix":"","firstName":"Aleksey","middleName":"Petrovich","lastName":"Prizov","suffix":""},{"id":627907796,"identity":"c3cddd92-20d7-47d2-a073-b4e3c8aad3c1","order_by":3,"name":"Vitaliy Sergeevich Cherkasov","email":"","orcid":"","institution":"Department of Orthopedics of the Moscow Clinical Hospital No. 31 named after Academician G.M. Savelyeva","correspondingAuthor":false,"prefix":"","firstName":"Vitaliy","middleName":"Sergeevich","lastName":"Cherkasov","suffix":""},{"id":627907797,"identity":"83ccd091-c15f-4079-a6dd-a318b1dc6108","order_by":4,"name":"Vadim Fedorovich Naydanov","email":"","orcid":"","institution":"Department of Orthopedics of the Moscow Clinical Hospital No. 31 named after Academician G.M. Savelyeva","correspondingAuthor":false,"prefix":"","firstName":"Vadim","middleName":"Fedorovich","lastName":"Naydanov","suffix":""},{"id":627907798,"identity":"fc1230fb-8262-4b12-995e-1f40f6f4d6c3","order_by":5,"name":"Asadula Raufovich Abasov","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYJACCYYCMAkCNgwMzMwNRGgxgGtJA2phJE3LYSAmoIW///DD2zwGdgz8s5sff/jYdj6av52xgbmyDY8NN9KMrXkMkhkk7hwzk5zZdjt3xmHGBsazeLQw3GAwk+YxYAYyEsyYec7czm0AaWnEo0X+/PFvQC31DPI30j9/5jlzLnc+IS0GB3JAthxmMLiRYyDNU3EgdwMhLYY3coot5xgcZzC8c6ZMckZFcu5GoJaDDedwa5E7f3zjjTcV1Qxyt9s3f/hgYJc77/zhgw8byvB4HwrqG5B5BwhrGAWjYBSMglGADwAApBVS1n+vFRMAAAAASUVORK5CYII=","orcid":"","institution":"RUDN University","correspondingAuthor":true,"prefix":"","firstName":"Asadula","middleName":"Raufovich","lastName":"Abasov","suffix":""},{"id":627907799,"identity":"85c355d4-a85c-4572-862c-a40beafa73ac","order_by":6,"name":"Konstantin Aslanovich Dzampaev","email":"","orcid":"","institution":"Department of Orthopedics of the Moscow Clinical Hospital No. 31 named after Academician G.M. Savelyeva","correspondingAuthor":false,"prefix":"","firstName":"Konstantin","middleName":"Aslanovich","lastName":"Dzampaev","suffix":""},{"id":627907800,"identity":"b971dac5-6c0c-4731-a19e-a3739888cd44","order_by":7,"name":"Dmitriy Karoevich Suleymanyants","email":"","orcid":"","institution":"Department of Orthopedics of the Moscow Clinical Hospital No. 31 named after Academician G.M. Savelyeva","correspondingAuthor":false,"prefix":"","firstName":"Dmitriy","middleName":"Karoevich","lastName":"Suleymanyants","suffix":""}],"badges":[],"createdAt":"2026-04-19 17:38:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9463987/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9463987/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107692350,"identity":"7f504703-080e-4a2f-a638-97c8f679be71","added_by":"auto","created_at":"2026-04-24 06:22:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":683922,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical case of acetabular defect replacement in a patient with chronic instability of the right hip joint. A - Dislocation of the femoral component in combination with dislocation of the protrusion ring, B, C - Custom 3D component for replacing the formed acetabular defect, D - Implantation of the component, fixation with pins, E - A cemented cup is installed, the prosthesis is adjusted and stable.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/96703352e50b1bd77175a85b.png"},{"id":107692352,"identity":"9b9708ca-3c1c-466f-8809-1057b8cbb04d","added_by":"auto","created_at":"2026-04-24 06:22:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":288516,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiographs of the patient after installation of a custom 3D acetabular component.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/30ff64b9a5415b777bf35412.png"},{"id":107692355,"identity":"b8864d00-bdd2-4eb8-9966-9acd9069d5f2","added_by":"auto","created_at":"2026-04-24 06:22:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":313048,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiographs 9 years after surgery. A - Radiograph with dislocation of the endoprosthesis head; B - Radiograph after installation of the dual mobility system.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/c7a894a3b4fc93e389dfad74.png"},{"id":107692353,"identity":"84a8aa23-03b2-46f4-a8cd-41226ed95977","added_by":"auto","created_at":"2026-04-24 06:22:55","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":241666,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiographs of a patient with aseptic instability of the acetabular component. A - Radiograph before surgery. Acetabular defect with separation of the pelvic ring (Paprosky 3B); B - Radiograph after surgery. A custom implant was installed.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/a1e8f5555d434758655664db.png"},{"id":107708006,"identity":"b77af03f-2556-4c34-b8f1-93888a113364","added_by":"auto","created_at":"2026-04-24 09:21:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":194114,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e3D planning of acetabular defect replacement. A - segmentation of the pelvic defect in a 3D model, B - planning the direction of screws for implant fixation, D - assessment of the possibility of compensating for bone deficiency\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/26ee1eea8f3d615039b7bd83.png"},{"id":107708116,"identity":"dd5e8cbe-a030-4384-b7c5-57fd1cda794d","added_by":"auto","created_at":"2026-04-24 09:22:03","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":368541,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInstructions for implantation of a custom component\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/aa7ce336b5359d7e887eb734.png"},{"id":107707995,"identity":"0124f8df-7412-4d0e-922a-d79229db33b0","added_by":"auto","created_at":"2026-04-24 09:21:35","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":402472,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical case with a massive acetabular defect combined with a dislocation of the hip joint spacer. A - Radiograph before the surgery; B - 3D model of the pelvic bones in real size for intraoperative component orientation, try-in components, inserts-guides for screw insertion; B - Custom 3D augmentation and its try-in template; D - Custom 3D component and its trial template.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/bdf13772208326170a419255.png"},{"id":107707999,"identity":"10888ffb-c423-4c45-9fc6-e71eb6fbae69","added_by":"auto","created_at":"2026-04-24 09:21:37","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":276014,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiograph after the surgery\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-9463987/v1/32333ceec9b972e2ea50cd60.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Genuine experience in the use of individual 3D implants in complex revision arthroplasty of large joints","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCurrently, large joint replacement has become a routine procedure in modern surgery, essential for any traumatology or orthopedic department. The number of patients requiring this procedure increases annually worldwide. Consequently, the number of revision joint replacements also tends to increase annually. The most common reasons for revision procedures are instability of the endoprosthesis components, both aseptic and infectious [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, revision surgery can be performed multiple times on the same patient. With each revision procedure, the amount of bone tissue in the joint area decreases, requiring a greater variety of options to fill bone defects. Commercially available augments, cones, and sleeves are not always sufficient to address significant bone loss. Therefore, to improve treatment outcomes, patients with extensive bone defects require custom-made implants tailored to their joint anatomy.\u003c/p\u003e \u003cp\u003eIn 1984, thanks to the work of the American engineer Charles W. Hull, 3D printing technology was invented and patented. While primarily used in the industrial sector, this rapidly developing method also attracted attention in medical science [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Particular interest began to emerge in the field of custom-made implants, which facilitated the task of the operating surgeon and provided a way out of a difficult situation for the patient. Today, the technology for creating and using custom 3D implants is actively used in all areas of orthopedics, from maxillofacial surgery to endoprosthetics of small joints of the hand [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Orthopedics Department of Moscow Clinical Hospital No. 31, the first patient with an extensive acetabular defect underwent surgery with a custom-made 3D implant in 2017 (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In this clinical case, the acetabular defect arose due to instability of the acetabular component of the hip joint, which could not be compensated for with standard revision components.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis clinical case is also noteworthy in that nine years after the installation of the custom 3D acetabular component, the patient developed recurrent dislocations of the prosthetic head (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). We resolved this complication by removing the cemented acetabular component from the 3D implant and installing a dual mobility system (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBy 2025, 37 of 281 revision hip replacements using 3D technology were required. This research paper presents the treatment outcomes for patients using custom-made hip replacement components, as well as the approach and design principles for 3D implants.\u003c/p\u003e\n\u003ch3\u003eThe aim\u003c/h3\u003e\n\u003cp\u003eThe aim of this study is to improve treatment outcomes for patients with extensive bone defects after large joint replacement by analyzing and determining the optimal approach to preoperative planning, surgical intervention, and the postoperative period using personalized 3D implants.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe present our experience treating 37 patients with extensive bone defects who required the fabrication and installation of custom-made 3D implants. This study was conducted at the Department of Traumatology and Orthopedics, Patrice Lumumba Peoples' Friendship University of Russia, and the Orthopedics Department of the G.M. Savelyeva Clinical Hospital No. 31, Moscow Health Department.\u003c/p\u003e\n\u003ch3\u003eThe Sample structure\u003c/h3\u003e\n\u003cp\u003eFrom July 1, 2025, to March 1, 2026, 281 revision procedures were performed. The percentage distribution of revision hip, knee, and shoulder arthroplasty procedures during the study period was 149 (53%), 119 (42%), and 13 (5%), respectively. We clearly differentiated the reasons for the procedures. In 96 (34%) cases, revision was due to aseptic component instability, while in 185 (66%) cases, revision was performed as part of the second stage of revision arthroplasty for periprosthetic infection. The total number of procedures using 3D custom-made implants was 37 (13.2%).\u003c/p\u003e \u003cp\u003eIn terms of gender, 100% of patients were women, with an average age of 68\u0026thinsp;\u0026plusmn;\u0026thinsp;7,4 years (min \u0026ndash; 44; max \u0026ndash; 82).\u003c/p\u003e \u003cp\u003eThe study group included 37 patients, 27 of whom had an articulating spacer in place at the time of hospitalization for the treatment of deep periprosthetic joint infections of the hip (13 cases), knee (11 cases), and shoulder (3 cases).\u003c/p\u003e \u003cp\u003eNine patients in the sample had bone defects associated with aseptic loosening of the acetabular component of the hip joint (HJ) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn one clinical case of knee arthroplasty with a endoprosthesis, osteolysis of the distal femur was observed, followed by loosening of the femoral component, secondary to an existing peri-implant fracture.\u003c/p\u003e\n\u003ch3\u003eRadiographic assessment\u003c/h3\u003e\n\u003cp\u003eAll patients underwent a standard preoperative examination protocol, which included mandatory radiographs and computed tomography of the affected joint. Bone loss was assessed using the generally accepted Paprosky classification for hip joint defects and the AORI classification for knee joint defects. Given that there is currently no standardized classification for shoulder joint defects in revision surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], we used the G. Kocsis classification, proposed in 2016, to assess shoulder defects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Postoperatively and during outpatient follow-up, all patients underwent follow-up radiographs of the operated joint.\u003c/p\u003e\n\u003ch3\u003eFunctional Outcome Assessment\u003c/h3\u003e\n\u003cp\u003eFunctional outcomes were assessed during follow-up consultations with patients using well-established scales: the Harris Hip Score (HHS) for the hip joint, the Knee Society Score (KSS) for the knee joint, and the Oxford Shoulder Score (OSS) for the shoulder joint [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe results of qualitative indicators are presented as absolute numbers (n) with percentage calculations. Normally distributed quantitative indicators were described by means and standard deviations (SD). For quantitative indicators whose distributions differed from normal, the median and the values ​​of the 1st and 3rd quartiles [Q1;Q3] were calculated.\u003c/p\u003e \u003cp\u003ePatients' electronic medical records were reviewed in the Unified Information and Analytical System (EMIAS) in accordance with their consent to the processing of personal data. Radiographs and CT scans were reviewed and analyzed using RadiAnt DICOM viewer 2025.2 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA review of 37 electronic patient records from the sample revealed that, regardless of whether the infectious or aseptic process had been resolved, massive defects uncompensated by local tissues and standardized augments were observed in the acetabulum in all cases of revision hip surgery. In contrast, standard revision devices, such as the Wagner stem with distal fixation, were successfully installed in all cases of femoral defects. The observed bone loss in the acetabular roof and columns, combined with protrusion, corresponds to a type 3B defect according to the Paprosky classification.\u003c/p\u003e \u003cp\u003eIn 11 cases of knee revision, extensive AORI type III defects of the proximal tibia were observed in 9 patients (82%). Notably, in all cases, the reason for revision was periprosthetic infection, which was treated with an articulating spacer.\u003c/p\u003e \u003cp\u003eA single case of aseptic loosening of the femoral component of a knee replacement was observed in a patient with a peri-implant fracture of the distal femur. We believe that the combination of these factors should be considered a vicious cycle, in which unstable fixation of the revision component stem at the fracture site leads to loosening, which in turn contributes to endosteal bone loss and prevents fracture consolidation. In this case, this effect resulted in the formation of an extended femoral defect\u0026mdash;AORI type III.\u003c/p\u003e \u003cp\u003eIn the case of using 3D technology in revision shoulder arthroplasty, an important feature was the presence of anterior instability of the articulating spacer of the shoulder joint. This factor necessitated the use of a 3D component to restore humeral length and create additional shoulder joint volume to achieve satisfactory deltoid muscle function.\u003c/p\u003e \u003cp\u003eAll patients, upon verification of extensive bone defects, underwent 3D planning of custom implants based on CT scans in collaboration with engineers involved in the production of these medical devices (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The average time from initial presentation to hospitalization for patients in the study group was 3.5 months.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWithin the specified timeframe, a CT scan of the affected joint was sent by an orthopedic traumatologist to the manufacturer, detailing the proposed surgical procedure. Throughout the 3D modeling and component printing process, active communication was maintained between the company's engineer and the attending physician. This collaboration resulted in the creation of a standardized, customized kit for our clinic, including a 3D component required for intraoperative testing prior to primary implant placement, a personalized 3D component made of trabecular metal (titanium alloy), and a personalized instrument for its installation. The kit must include detailed implantation instructions and patient information, including the patient's last name, first name, patronymic, and the joint being operated on (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The test and primary components, as well as the guide instruments, are sterilized 24 hours before the revision procedure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe average surgical duration in the study group was 2.8 hours for hip revision and 2.4 hours for knee revision. Surgeries on the shoulder lasted 2.5 hours. In 2017, the average surgical time for revision hip arthroplasty was 3.5 hours. In addition to targeted treatment of the compromised joint, this time includes surgical access, removal of the implants, treatment of the articulating portion of the endoprosthesis, copious irrigation, and layered wound closure (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of the volume of bone mass deficiency with the time of implant production and surgical intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003cp\u003e(gender, age)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocalization of the defect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVolume of bone deficiency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eName of 3D implant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFunctional result\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOperation time (hour)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePlanning timeframe (months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHip joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 44 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC - Custom Triflange Acetabular Component\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 59 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 60 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u0026thinsp;+\u0026thinsp;modular individual augment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 7 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 65 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 6 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 66 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u0026thinsp;+\u0026thinsp;modular individual augment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 7 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 68 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 7 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 68 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u0026thinsp;+\u0026thinsp;modular individual augment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 74 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 76 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 78 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 79 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC+\u003c/p\u003e \u003cp\u003emodular individual augment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaprosky 3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCTAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHHS 69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eKnee joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 63\u003c/p\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 66 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistal Femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModular individual augment of distal femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 66 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 68 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 68 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistal Femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModular individual augment of distal femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 75 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 75 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibial Plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAORI III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 D Augment of plateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKSS 83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eShoulder joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHumerus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProximal third of the bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3D Augment of the proximal third of the bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOSS 32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlenoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCocsis III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3D Augment of the neck and glenoid of the scapula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOSS 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe early postoperative period was uneventful in all clinical observations. Patients underwent a standardized series of examinations, including control radiography of the joint, ultrasound examination of the deep veins of the lower extremities, and electrocardiogram monitoring. Medication therapy included broad-spectrum antibiotic prophylaxis, thromboprophylaxis with indirect anticoagulants, and pain management with narcotic and non-narcotic agents.\u003c/p\u003e \u003cp\u003eThe average hospital stay in the postoperative period was 8.7 days. In the late postoperative period, all patients underwent outpatient follow-up radiographs of the operated joints at intervals of 6 weeks, 3 months, 6 months, and 12 months. In all clinical cases, implant placement was assessed as correct, consistent with the initial positioning, with no signs of osteolysis in the peri-implant area.\u003c/p\u003e \u003cp\u003eAs part of the 6-month follow-up of the sample of patients, a questionnaire was administered using the scales mentioned in the study methods. The median HHS value was 71 [67; 73] points, which corresponds to normal hip joint function. The median KSS value was 79 [76; 84] points, which corresponds to good function of the operated knee joint. The OSS score in the case of glenoid articular surface replacement with a 3D implant was 40 points, but in the case of proximal humerus replacement, the functional score was 32 points, which primarily emphasizes the difficulty in restoring adequate function in post-traumatic arthrosis with a significant and long-term bone mass deficiency.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis experience using custom-made 3D implants in revision arthroplasty of large joints demonstrates the effectiveness of this technology in treating patients with extensive bone defects. The results obtained are consistent with current global data and confirm the feasibility of using personalized implants in the most complex clinical situations.\u003c/p\u003e \u003cp\u003eSince our first experience with custom-made implants, 3D modeling technology has undergone significant changes. These changes primarily affect the metal structure preparation process itself: complete continuity and collaboration between the surgeon and engineer during the preparatory stage, the transition from monolithic to modular structures, the creation of detailed instructions specifying the size and direction of fixation screws, and the creation of plastic mock-ups, which significantly facilitate preoperative preparation. These changes now facilitate the compensation of complex defects with full understanding and control of the surgical procedure (Figs.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e The functional results obtained in our study are comparable to those of leading centers worldwide. The mean HHS of 71,5 points corresponds to normal hip function and correlates with the results of the study by Fang et al., where HHS improved from 47.8 to 86.4 points at a mean follow-up of 41.5 months [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKong et al. reported an improvement in HHS from 33.5 to 86.1 points using a combination of custom-made 3D-printed titanium augments with tantalum cups at a mean follow-up of 4.7 years. The KSS of 79.7 points in our series also demonstrates good knee function, which is consistent with the data of Cherny et al., who noted a significant improvement in functional indicators with the use of custom cones in revision knee arthroplasty [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe average time from initial presentation to hospitalization of 3.5 months in our practice is acceptable given the need for careful planning and fabrication of custom-made components. Giachino et al. demonstrated that the use of 3D-printed models for preoperative planning for type 3 Paprosky defects resulted in a shorter operative time (101.8 min vs. 146.1 min), a reduced rate of intraoperative complications (19% vs. 62.5%), and significant cost savings (a difference of \u0026euro;4,183) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Dos Santos-Vaquinhas et al. also confirmed that preoperative planning using 3D models reduced surgical time and improved functional outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe average surgical time (2.8 hours for hip, 2.4 hours for knee, and 2.5 hours for shoulder) is acceptable for revision procedures of this complexity, and the reduction in the time required for these procedures compared to those performed in 2017 (3.5 hours) indicates progress and improvement in surgical technique. The absence of intraoperative interventions and a smooth early postoperative period in all cases indicate good preparation and adequate surgical planning.\u003c/p\u003e \u003cp\u003eThe absence of signs of osteolysis and implant retention in follow-up radiographs in the long-term period is consistent with the data of a systematic review by Almeida et al., which showed a survival rate of 95.52% for highly porous 3D-printed titanium acetabular cups with a mean follow-up of 3.8 years [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Di Laura et al. A 100% survival rate of individual 3D-printed implants for Paprosky 3B defects with foci of osseointegration was shown in 92% of patients after 12 months [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a previously demonstrated clinical case of hip joint endoprosthesis dislocations 9 years after installation of a custom 3D implant, we attribute this to an extensive bone defect in the proximal femur, and therefore, a disruption of the abductor mechanism. The hip abductors (the gluteus medius and minimus) play a critical role in maintaining endoprosthesis stability. Computer modeling shows that the gluteus medius provides approximately 48.3% of the resistance during hip flexion, preventing anterior dislocation. Abductor insufficiency disrupts the dynamic stabilization of the endoprosthesis head in the acetabulum, significantly increasing the risk of dislocation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. With severe insufficiency or complete absence of the abductor mechanism, the incidence of dislocations increases sharply. Studies show that a compromised abductor apparatus increases the risk of dislocation with an odds ratio of 43.1 (95% CI: 3.18\u0026ndash;586.3)\u0026mdash;it is the most significant independent risk factor [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prioritization of dual-mobility systems for proximal femoral defects and the placement of 3D components is a valid strategy. Canetti et al. demonstrated that the use of dual-mobility systems in combination with a proximal femoral endoprosthesis limits the risk of dislocation to 7.5% with a dislocation-free survival rate of 94% at 1 year, which is significantly better than the results obtained with larger femoral heads in other studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Hitz et al. demonstrated that the use of a dual-mobility system cemented into a tantalum cup in large bone defects reduces the risk of dislocation without increasing the risk of mechanical complications, with a dislocation-free survival rate of 96% at 5 years [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe expansion of indications for the use of dual-mobility systems in revision arthroplasty is supported by multiple studies. Unter Ecker et al. reported dislocation-free survival of 96% at 5 years and 82% at 9 years when using dual-mobility systems in complex revision cases with massive bone and soft tissue loss [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Ameztoy Gallego et al. demonstrated a dual-mobility system survival rate of 82.4% at 7 years in patients with a high risk of instability, with a dislocation rate of only 2.1% [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Khatod et al. confirmed in a large cohort study that revision arthroplasty using dual mobility systems has the lowest risk of revision and dislocation compared to other types of designs [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimitations of our study include a relatively small sample size (37 patients), the lack of a control group, and a relatively short follow-up period (6 months for functional evaluation). Furthermore, all patients in our series were women, which may limit the generalizability of the results. A systematic review by Chiarlone et al. found that the average reoperation rate for custom-made acetabular components was 19.3%, while the re-revision rate was 5.2% with a mean follow-up of 58.6 months, highlighting the need for long-term follow-up of our patients [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe presented experience with the use of custom-made 3D-printed implants in revision arthroplasty of large joints demonstrates the evolution of technology and surgical technique from 2017 to 2025. The annual increase in primary endoprosthetics naturally leads to an increase in revision procedures. With each subsequent revision, bone loss in the same patient progressively worsens, leading to a growing need for customized 3D-printed solutions.\u003c/p\u003e \u003cp\u003eAccumulated clinical experience has enabled the optimization of surgical techniques, resulting in a reduction in surgical time from 3.5 hours for the first procedure in 2017 to 2.8 hours today.\u003c/p\u003e \u003cp\u003eThe transition from monolithic to modular 3D-printed structures represents a significant technological advancement, providing greater flexibility in intraoperative implant placement. Modular systems allow the surgeon to perform more precise adjustments to anteversion, offset, and limb length, which is especially important for extensive bone defects. The occurrence of endoprosthesis dislocations, even late after the initial placement of a custom 3D implant, highlights the importance of long-term patient follow-up and the need for additional strategies to prevent dislocations. The successful resolution of recurrent dislocations by installing a dual mobility system is consistent with current literature data demonstrating the high efficacy of this technology in revision arthroplasty.\u003c/p\u003e \u003cp\u003eThe use of individual 3D printed trabecular titanium implants is an effective treatment method for patients with extensive Paprosky 3B type bone defects in revision hip arthroplasty and AORI type III in revision knee arthroplasty, providing satisfactory functional results (HHS 71 [67;73] points, KSS 79 [76;84] points) with an average follow-up period of 6 months.\u003c/p\u003e \u003cp\u003eThe technology for 3D printing custom implants continues to evolve, and accumulating clinical experience allows for refinement of surgical techniques, reduction of operating time, and improved treatment outcomes. The transition to modular designs and the prioritization of dual-mobility systems for patients with a high risk of postoperative dislocation represent a logical evolution in the treatment approach for patients with extensive bone defects. However, continued long-term patient follow-up is necessary to definitively assess the efficacy and durability of these technologies, especially given that most published studies have an average follow-up period of 3 to 5 years.\u003c/p\u003e \u003cp\u003eDespite the high cost of custom-made implants, the cost-effectiveness of this approach can be justified by a reduced rate of revision surgery, shorter operative time, and improved functional outcomes. Further studies with larger sample sizes, control groups, and long-term follow-up are needed to definitively evaluate the efficacy and durability of custom-made 3D-printed implants in revision arthroplasty of large joints.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. The first dataset used in the study was approved by the Department of Traumatology and Orthopedics at Peoples\u0026apos; Friendship University of Russia named after Patrice Lumumba. All participants provided written informed consent for use of their data prior to participation. For the second dataset used in the study, ethical approval was not required as confirmed by the Hospital named after Academician G.M. Savelieva ethics committee, since the radiography data were anonymized and collected during routine clinical care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Consent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Competing interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe radiography and photo dataset analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research did not receive any funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.D.,K.D.,G.A., A.P. gave information about clinical cases\u003c/p\u003e\n\u003cp\u003eV.C.,D.S., V.N., \u0026nbsp;prepared figures, found references\u003c/p\u003e\n\u003cp\u003eA.A., I.D. wrote the main manuscript text\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTikhilov R.M. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases) / Tikhilov R.M., Shubnyakov I.I., Denisov A.O. // Traumatology and Orthopedics of Russia \u0026ndash; 2019. \u0026ndash; Т. 25 \u0026ndash; № 1 \u0026ndash; С.122\u0026ndash;141.\u003c/li\u003e\n\u003cli\u003e[Ivanov P.P., Kornilov N.N., Kulyba T.A., SURGICAL INTERVENTIONS FOR TREATMENT OF INFECTED TOTAL KNEE ARTHROPLASTY (LITERATURE REVIEW)// The Department of Traumatology and Orthopedics. 2017.№1(21). p.35-43]\u003c/li\u003e\n\u003cli\u003eRai A.K. Functional Outcomes and a Review of Management Options for Revision Shoulder Arthroplasty / Rai A.K., Kumar K. // Malaysian Orthopaedic Journal \u0026ndash; 2024. \u0026ndash; Т. 18 \u0026ndash; № 2 \u0026ndash; С.18\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eSharma N.R. Applications of 3D printing in Biomedical Engineering / Sharma N.R., Subburaj K., Sandhu K., Sharma V. // Applications of 3D Printing in Biomedical Engineering \u0026ndash; 2021. \u0026ndash; С.1\u0026ndash;213.\u003c/li\u003e\n\u003cli\u003eYarikov A. Yarikov A., Gorbatov R., Stolyarov I. et al. Application of additive 3D printing technologies in traumatology/orthopedics and neurosurgery / Yarikov A., Gorbatov R., Stolyarov I., Smirnov I., Fraerman A. // Vrach \u0026ndash; 2021. \u0026ndash; Т. 32 \u0026ndash; № 10 \u0026ndash; С.8\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eAckland D.C. A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation / Ackland D.C., Robinson D., Redhead M., Lee P.V.S., Moskaljuk A., Dimitroulis G. // Journal of the Mechanical Behavior of Biomedical Materials \u0026ndash; 2017. \u0026ndash; Т. 69 \u0026ndash; № September 2016 \u0026ndash; С.404\u0026ndash;411.\u003c/li\u003e\n\u003cli\u003eZheng H. Clinical study of 3D-printed personalized prostheses for the treatment of traumatic metacarpophalangeal joint defects / Zheng H., Cao Y., Wang Y., Jia Z., Liu Y. // BMC Musculoskeletal Disorders \u0026ndash; 2025. \u0026ndash; Т. 26 \u0026ndash; № 1.\u003c/li\u003e\n\u003cli\u003eGoldman B.H. Management of Revision Reverse Shoulder Arthroplasty / Goldman B.H., Halpern A.L., Deal M.J., Richey B.P., Mason E.M., Gupta H.O., Callegari J., Bravo C.J. // Journal of Shoulder and Elbow Arthroplasty \u0026ndash; 2020. \u0026ndash; Т. 4.\u003c/li\u003e\n\u003cli\u003eDriscoll D.A. Reliability and validity of the Paprosky classification for acetabular bone loss based on level of orthopedic training / Driscoll D.A., Ricotti R.G., Malahias M.A., Nocon A.A., Bornes T.D., Tarity T.D., Tam K., Premkumar A., Pirzada W.U., Boettner F., Sculco P.K. // Archives of orthopaedic and trauma surgery \u0026ndash; 2024. \u0026ndash; Т. 144 \u0026ndash; № 9.\u003c/li\u003e\n\u003cli\u003eKocsis G. A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder / Kocsis G., Thyagarajan D.S., Fairbairn K.J., Wallace W.A. // Bone and Joint Journal \u0026ndash; 2016. \u0026ndash; Т. 98B \u0026ndash; № 3 \u0026ndash; С.374\u0026ndash;380.\u003c/li\u003e\n\u003cli\u003eRaab D. Do we still need to screen our patients?-Orthopaedic scoring based on motion tracking / Raab D., Heitzer F., Liaw J.C., M\u0026uuml;ller K., Weber L., Flores F.G., Kecskem\u0026eacute;thy A., Mayer C., J\u0026auml;ger M. // International orthopaedics \u0026ndash; 2023. \u0026ndash; Т. 47 \u0026ndash; № 4 \u0026ndash; С.921\u0026ndash;928.\u003c/li\u003e\n\u003cli\u003eLiu P. Changes and thresholds in the Oxford Shoulder Score following shoulder arthroplasty: Minimal clinically important difference, minimal important and detectable changes, and patient-acceptable symptom state / Liu P., Afzal I., Asopa V., Clement N.D., Patel V. // Shoulder \u0026amp; elbow \u0026ndash; 2024. \u0026ndash; Т. 16 \u0026ndash; № 5 \u0026ndash; С.507\u0026ndash;517.\u003c/li\u003e\n\u003cli\u003eFang S. Three-dimensional-printed titanium implants for severe acetabular bone defects in revision hip arthroplasty: short- and mid-term results / Fang S., Wang Y., Xu P., Zhu J., Liu J., Li H., Sun X. // International Orthopaedics \u0026ndash; 2022. \u0026ndash; Т. 46 \u0026ndash; № 6 \u0026ndash; С.1289\u0026ndash;1297.\u003c/li\u003e\n\u003cli\u003eKong K. Use of Customized 3D-Printed Titanium Augment With Tantalum Trabecular Cup for Large Acetabular Bone Defects in Revision Total Hip Arthroplasty: A Midterm Follow-Up Study / Kong K., Zhao C., Chang Y., Qiao H., Hu Y., Li H., Zhang J. // Frontiers in Bioengineering and Biotechnology \u0026ndash; 2022. \u0026ndash; Т. 10 \u0026ndash; № June \u0026ndash; С.1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eCherny A.A. A prospective study on outcome of patient-specific cones in revision knee arthroplasty / Cherny A.A., Kovalenko A.N., Kulyaba T.A., Kornilov N.N. // Archives of orthopaedic and trauma surgery \u0026ndash; 2021. \u0026ndash; Т. 141 \u0026ndash; № 12 \u0026ndash; С.2277\u0026ndash;2286.\u003c/li\u003e\n\u003cli\u003eGiachino M. Impact of three-dimensional printed planning in Paprosky III acetabular defects: a case-control and cost-comparison analysis / Giachino M., Aprato A., Limone B., Ciccone G., Rosso T., Mass\u0026egrave; A. // International orthopaedics \u0026ndash; 2023. \u0026ndash; Т. 47 \u0026ndash; № 6 \u0026ndash; С.1465\u0026ndash;1472.\u003c/li\u003e\n\u003cli\u003eSantos-Vaquinhas A. Dos Improvement of surgical time and functional results after do-it-yourself 3D-printed model preoperative planning in acetabular defects Paprosky IIA-IIIB / Santos-Vaquinhas A. Dos, L\u0026oacute;pez-Torres I.I., Matas-Diez J.A., Calvo-Haro J.A., Vaquero J., Sanz-Ruiz P. // Orthopaedics and Traumatology: Surgery and Research \u0026ndash; 2022. \u0026ndash; Т. 108 \u0026ndash; № 6.\u003c/li\u003e\n\u003cli\u003eAlmeida P.R. The Use of Highly Porous 3-D-Printed Titanium Acetabular Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis / Almeida P.R., Macpherson G.J., Simpson P., Gaston P., Clement N.D. // Journal of clinical medicine \u0026ndash; 2025. \u0026ndash; Т. 14 \u0026ndash; № 3.\u003c/li\u003e\n\u003cli\u003eLaura A. Di Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results / Laura A. Di, Henckel J., Hart A. // JB \u0026amp; JS open access \u0026ndash; 2023. \u0026ndash; Т. 8 \u0026ndash; № 2.\u003c/li\u003e\n\u003cli\u003eYang H. Hip Stability After Total Hip Arthroplasty: Quantifying Capsule and Passive Muscle Contributions / Yang H., Colone K., Haas B., Myers C.A., Rullkoetter P.J., Clary C.W. // Journal of orthopaedic research : official publication of the Orthopaedic Research Society \u0026ndash; 2025. \u0026ndash; Т. 43 \u0026ndash; № 10 \u0026ndash; С.1826\u0026ndash;1839.\u003c/li\u003e\n\u003cli\u003eHuten D. Risk factors for dislocation after revision total hip arthroplasty with a dual-mobility cup. Matched case-control study (16 cases vs. 48 controls) / Huten D., Fournier Y., Gicquel T., Bertho P., Basselot F., Hamadouche M. // Orthopaedics and Traumatology: Surgery and Research \u0026ndash; 2019. \u0026ndash; Т. 105 \u0026ndash; № 7 \u0026ndash; С.1303\u0026ndash;1309.\u003c/li\u003e\n\u003cli\u003eCanetti R. Dual mobility cups associated with proximal femoral replacement in nontumoral indications: Results and complications / Canetti R., Malatray M., Pibarot V., Wegrzyn J. // Orthopaedics and Traumatology: Surgery and Research \u0026ndash; 2022. \u0026ndash; Т. 108 \u0026ndash; № 2.\u003c/li\u003e\n\u003cli\u003eHitz O. Use of dual mobility cup cemented into a tantalum acetabular shell for hip revision with large bone loss can decrease dislocation risk without increasing the risk of mechanical failure / Hitz O., Baron M. Le, Jacquet C., Argenson J.N., Parratte S., Ollivier M., Flecher X. // Orthopaedics and Traumatology: Surgery and Research \u0026ndash; 2024. \u0026ndash; Т. 110 \u0026ndash; № 2.\u003c/li\u003e\n\u003cli\u003eUnter Ecker N. What Is the Dislocation and Revision Rate of Dual-mobility Cups Used in Complex Revision THAs? / Unter Ecker N., Kocaoǧlu H., Zahar A., Haasper C., Gehrke T., Citak M. // Clinical orthopaedics and related research \u0026ndash; 2021. \u0026ndash; Т. 479 \u0026ndash; № 2 \u0026ndash; С.280\u0026ndash;285.\u003c/li\u003e\n\u003cli\u003eAmeztoy Gallego J. Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability / Ameztoy Gallego J., Cruz Pardos A., Gomez Luque J., Cuadrado Rubio L.E., Fern\u0026aacute;ndez Fern\u0026aacute;ndez R. // International orthopaedics \u0026ndash; 2023. \u0026ndash; Т. 47 \u0026ndash; № 7 \u0026ndash; С.1757\u0026ndash;1764.\u003c/li\u003e\n\u003cli\u003eKhatod M. Dual-Mobility Articulations in Revision Total Hip Arthroplasty: A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations / Khatod M., Chan P.H., Prentice H.A., Fasig B.H., Paxton E.W., Reddy N.C., Kelly M.P. // The Journal of bone and joint surgery. American volume \u0026ndash; 2024. \u0026ndash; Т. 106 \u0026ndash; № 24 \u0026ndash; С.2313\u0026ndash;2321.\u003c/li\u003e\n\u003cli\u003eChiarlone F. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature / Chiarlone F., Zanirato A., Cavagnaro L., Alessio-Mazzola M., Felli L., Burastero G. // Archives of orthopaedic and trauma surgery \u0026ndash; 2020. \u0026ndash; Т. 140 \u0026ndash; № 3 \u0026ndash; С.415\u0026ndash;424.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9463987/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9463987/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNowadays, large joint replacement surgery has become a routine procedure in modern surgery, essential for every trauma and orthopedic department. Every year, more and more patients are born worldwide who require this procedure. Consequently, the number of revision joint replacements is increasing annually. With each revision, the amount of bone tissue in the joint area diminishes. Commercially manufactured augments, cones, and sleeves are not always sufficient to address significant bone loss. Therefore, to improve treatment outcomes, patients with extensive bone defects require custom-made implants tailored to their joint anatomy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe aim\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe aim of this work is to improve the treatment outcomes of patients with extensive bone defects after large joint arthroplasty by analyzing and determining the optimal approach to preoperative planning, surgical intervention and the postoperative period using personalized 3D implants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMaterials and Methods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe present our experience treating 37 patients with extensive bone defects who required the fabrication and installation of personalized 3D implants for Hip, Knee and Shoulder joints. Functional outcomes were assessed using joint-specific questionnaires.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAs part of the 6-month follow-up the median HHS value was 71 points, the median KSS value was 79 points, which corresponds to good function of the operated knee joint. The OSS score in the case of glenoid articular surface replacement with a 3D implant was 40 points, but in the case of proximal humerus replacement, the functional score was 32 points, which primarily emphasizes the difficulty in restoring adequate function in post-traumatic arthrosis with a significant and long-term bone mass deficiency.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe use of individual 3D printed trabecular titanium implants is an effective treatment method for patients with extensive Paprosky 3B type bone defects in revision hip arthroplasty and AORI type III in revision knee arthroplasty, providing satisfactory functional results. The technology for 3D printing custom implants continues to evolve, and accumulating clinical experience allows for refinement of surgical techniques, reduction of operating time, and improved treatment outcomes. Despite the high cost of custom-made implants, the cost-effectiveness of this approach can be justified by a reduced rate of revision surgery, shorter operative time, and improved functional outcomes. Further studies with larger sample sizes, control groups, and long-term follow-up are needed to definitively evaluate the efficacy and durability of custom-made 3D-printed implants in revision arthroplasty of large joints.\u003c/p\u003e","manuscriptTitle":"Genuine experience in the use of individual 3D implants in complex revision arthroplasty of large joints","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 06:22:44","doi":"10.21203/rs.3.rs-9463987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a444cfa-38d1-420f-a84b-8ad2653c79ba","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T08:11:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 06:22:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9463987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9463987","identity":"rs-9463987","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}