Innovative Custom-Made hip Resurfacing to Treat Osteoarthritis in the Presence of Retained Femoral Hardware: a Case Report

Background Treating hip osteoarthritis in the presence of retained proximal femoral hardware presents significant challenges. Conventional total hip arthroplasty techniques require hardware removal, which increases surgical complexity and risks and may not always be feasible, with reported success rate ranging from 85% and 95%. This case describes the innovative use of a custom-made hip resurfacing prosthesis combined with 3D-printed cutting guides to address the challenges posed by the non-removable hip screw plate. Case Presentation A 68-year-old female presented with advanced hip osteoarthritis and a retained hip screw plate that could not be removed due to extensive osseointegration. Conventional implants were not feasible as the plate and screw occupied the intramedullary space. A custom-made hip resurfacing prosthesis was designed to bypass the hardware entirely. 3D-printed cutting guides were utilized to ensure precise preparation of the femoral head surface, which enabled accurate implant placement to avoid the screw. Although an early postoperative infection occurred, it was successfully managed, and the patient achieved excellent functional recovery. Discussion This case highlights the limitations of existing solutions for managing retained hardware during total hip arthroplasty. While cutting guides are widely used in other orthopedic fields, their application in hip resurfacing with non-removable hardware is novel. These 3D-printed cutting guides, which are typically employed to enhance surgical precision in other procedures, were instrumental in ensuring accurate femoral head preparation and implant alignment in this case, thus reducing surgical risks and optimizing outcomes. This case demonstrates how the use of custom-made resurfacing implants and 3D-printed guides can address complex surgical challenges that conventional techniques cannot resolve, and, to the best of the authors' knowledge, it is the first reported case that utilized a custom-made resurfacing prosthesis combined with 3D-printed cutting guides.