Outcomes of primary total hip arthroplasty using custom femoral stems in patients with secondary hip osteoarthritis: a systematic review

Aims: This systematic review aims to evaluate the effectiveness and safety of custom femoral stems in primary total hip arthroplasty (THA) for patients with secondary osteoarthritis with abnormal hip anatomy.
Methods: Following PRISMA guidelines, databases were systematically searched for studies published on primary THA utilizing custom femoral stems. Inclusion criteria were studies on patients with secondary osteoarthritis receiving custom stems, with outcomes including implant survival, revision rates, and functional scores. Data were extracted from eligible studies, with a focus on overall and cause-specific revision rates.
Results: 689 studies were screened, 13 met the inclusion criteria, encompassing 806 patients and 951 custom THA procedures. The collective follow-up period averaged 11.6 years, with a mean age of 44.6 years. The mean reoperation and revision rates were 6.9% (95% CI: 3.24 – 10.13) and 8.25% (95% CI: 4.02 – 12.47) respectively. The mean intraoperative fracture rate was 3.23% (95% CI: 1.35 – 5.11) and the mean postoperative leg length discrepancy was 4.25mm (95% CI: 1.57-6.93). Mean improvement of postoperative Harris Hip Score as 40.32 ( range 30-56).
Conclusions: Custom femoral stems in primary THA demonstrate promising results in terms of implant survival and functional outcomes for patients with complex hip anatomy due to secondary osteoarthritis. These findings support the consideration of custom implants as a viable option for this patient demographic, though further research is warranted for long-term outcomes and direct comparisons with standard prostheses.