Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7605-7613
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7605
Total hip revision with custom-made spacer and prosthesis: A case report
Yang-Bo Liu, Hao Pan, Li Chen, Hao-Nan Ye, Cong-Cong Wu, Peng Wu, Lei Chen
Yang-Bo Liu, Hao Pan, Cong-Cong Wu, Peng Wu, Lei Chen, Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Li Chen, Orthopaedics Unit, St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
Hao-Nan Ye, First School of Clinical Medicine, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Liu YB, Pan H, and Chen L conducted the literature review; Liu YB, Pan H and Chen Li contributed to the drafting of the manuscript; Ye HN and Wu CC collected the medical records of this case; Chen L assisted in revising the manuscript; Wu P participated in surgical planning, surgery, and patient management; Chen L was the chief surgeon of the patient and was responsible for important revisions of the manuscript; all authors have read and approved the final version of the manuscript.
Informed consent statement: Informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lei Chen, MD, Director, Professor, Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou 325000, Zhejiang Province, China.
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 15, 2021
Revised: June 16, 2021
Accepted: July 15, 2021
Article in press: July 15, 2021
Published online: September 6, 2021

Both periprosthetic joint infections (PJIs) and severe femoral segmental defects are catastrophic complications of total hip arthroplasty (THA), and both present a significant challenge in revisional surgery. There are limited data available to guide clinical decision making when both occur concurrently.


A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision. Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect. Based on histological, radiological, laboratory, and clinical features, a diagnosis of concurrent chronic PJI and segmental femoral defect (Type IIIB, Paprosky classification) was made. After multidisciplinary team discussion, three-dimensional (3D)-printed, custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer. These were placed following PJI debridement in the first stage of revision surgery. After the PJI was eliminated, a 3D-printed, custom-made, femoral prosthesis was created to repair the considerable femoral defect. After 20-mo follow-up, the patient had excellent functional outcomes with a near-normal range of hip movement. So far, neither evidence of recurrent infection nor loosening of the prosthesis has been observed.


We describe a case of “two-stage, custom-made” total hip revision to treat PJI with a concurrent segmental femoral defect. Use of a personalized, 3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications. Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available. However, the long-term function, longevity, and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored.

Keywords: Total hip arthroplasty, Joint revision, Prosthesis-related infections, Bone loss, Bone cement, Antibiotics, Case report

Core Tip: This paper reports a pioneering technique where a 3D-printed, custom-made antibiotic spacer and femoral prosthesis were used in revisional surgery for a challenging case of periprosthetic joint infection with a concurrent femoral segmental defect after total hip arthroplasty. A review of other relevant cases from the literature is presented, and the potential challenges and solutions of novel, personalized reconstructive methods are discussed.