Discussion

This case demonstrates that anatomic reconstruction of a dysplastic hip using custom-made acetabular and femoral components can restore near-normal biomechanics with radiographic stability and meaningful functional gains. At two-year follow-up, clinical outcomes were favorable, with the patient reporting a high degree of satisfaction with the surgical result. Notably, however, THA using custom-made implants is associated with high rates of complications including infection, dislocation, and re-operation [21-23].

Despite using a DM cup within the CTAC (cup-in-cup technique) [24], with an acceptable range of component position, dislocation occurred in our case. Though primary THA with a DM cup is associated with a very low risk of dislocation [25-28], a 10.4% dislocation rate was reported after revision THA [29]. Solarino et al. [24] also reported that postoperative dislocation occurred in 3/16 patients undergoing DM THA with CTAC [30].

In our patient, chronic hip abductor and periarticular muscle atrophy, exacerbated by three years of wheelchair dependency, could have been the primary cause of instability [31]. Furthermore, compromised soft-tissue condition around the hip after childhood hip surgery precluded effective posterior soft-tissue repair. Lastly, sagittal spinal deformity and lumbar stiffness secondary to long-standing LLD further increased the dislocation risk by compromising spinopelvic balance [20]. Fortunately, there was no recurrence of dislocation thereafter [32].

Although customized implants are expensive and require extended production time, compared to the cost of managing early failures and revisions associated with standard implants or the debilitating pain the patient endures, the approach remains cost-effective [33]. However, when a surgeon encounters anatomical variations or poor bone quality, the options available to achieve primary stability become limited [23], and future long-term follow-up is needed to assess the survivorship of the new components.