Reconstruction by total hip replacement (THR) in patients with dislocated coxarthrosis presents special problems of dysplasia of the acetabulum and shortening of the limb. We designed a custom-made socket that consists of an ordinal cementless metal back socket with a long stem and a metal flange. The concept of the socket is to augment socket fixation by a long stem, to support it by connecting the metal flange with the iliac bone, and to contain grafted bone chips also by the flange.
Three custom-made sockets were implanted in two patients for dislocated coxarthrosis. Capsulotomy was performed prior to THR to pull down the femoral head at the anatomical level by gradual traction. The socket was machined with reference to the mold that was obtained at the time of capsulotomy and the Styrofoam model reconstructed from CT scan data. Structural autograft from the femoral head was performed at the supero-lateral portion of the acetabulum. The socket was fixed by the long stem and also was supported by the lateral metal flange that connected with the iliac bone. A morselized bone graft was then performed in the space contained by the iliac bone and the metal flange of the socket.
The follow-up periods were 2 and 4 years. In both cases, the clinical results were excellent. The union of the grafted bones was achieved and the remodeling was observed roentgeno-graphically. No migration of the sockets or collapse of the grafted bone was observed.
These results were limited due to the short-term follow-up, howerver our method was con-sidered one of the solutions for the acetabular bone deficiency.