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Objectives and questions: Custom-made acetabular components represent an important treatment option for complex acetabular defects where standard implants are not sufficient. Over the years, substantial advances of implant design and materials have improved stability, function, and longevity of implants. This article presents our experience with 154 custom-made acetabular implants, focusing on the effects of a modern surgical strategy and optimization of implant design on clinical, radiographic, and complication outcomes.

Material and methods: In this retrospective single-center study, 154 cases treated with CMAC over an 18-year period were analyzed; all reconstructions were performed for severe acetabular defects classified as Paprosky type 3A (n = 85) or 3B (n = 69), corresponding to ADC types 3C (n = 27), 4B (n = 58), and 4C (n = 69). Demographic data, implant design characteristics, and surgical techniques were recorded. Clinical outcomes were assessed using the Oxford Hip Score (OHS), all complications were recorded and radiographic evaluation was performed.

Results: The mean follow-up was 34.82 months (± 26.2 range, 6.2 – 168 months). The OHS significantly improved from a preoperative mean of 21.69 ± 5.59 to a postoperative mean of 30.93 ± 5.26. Kaplan–Meier analysis showed implant survival rates of 85% at 3 years, 78% at 5 years, and 62% at the latest follow-up of 168 months. The most frequent complications were periprosthetic infection (11%) and dislocation (10.4%).

Discussion and conclusions: Two decades of experience with 154 custom-made acetabular implants demonstrate clinical reliability of an individualized approach for complex acetabular reconstruction. Continuous design refinement has contributed to favorable mid-term outcomes and low complication rates. The findings underscore the importance of custom-made acetabular implant solutions in achieving durable hip function in challenging anatomical defect situations.