Effective treatment of large acetabular defects remains among the most challenging aspects of revision total hip arthroplasty (THA), due to the deficiency of healthy bone stock and degradation of the support columns. Generic uncemented components, which are favored in primary THA, are often unsuitable in revision cases, where the bone-implant contact may be insufficient for fixation, without significant reaming of the limited residual bone. This study presents a computational design strategy for automatically generating patient-specific implants that simultaneously maximize the bone-implant contact area, and minimize bone reaming while ensuring insertability. These components can be manufactured using the same additive manufacturing methods as porous components and may reduce cost and operating-time, compared to existing patient-specific systems. This study compares the performance of implants generated via the proposed method to optimally fitted hemispherical implants, in terms of the achievable bone-implant contact surface, and the volume of reamed bone. Computer-simulated results based on the reconstruction of a set of 15 severe pelvic defects (Paprosky 2A-3B) suggest that the patient-specific components increase bone-implant contact by 63% (median: 63%; SD: 44%; 95% CI: 52.3%–74.0%; RMSD: 42%), and reduce the volume of reamed bone stock by 97% (median: 98%; SD: 4%; 95% CI: 95.9%–97.4%; RMSD: 3.7%).

Patient-specific implants offer a host of benefits over their generic counterparts. Nonetheless, the design and optimization of these components present several technical challenges, among them being the need to ensure their insertability into the host bone tissue. This presents a significant challenge due to the tight-fitting nature of the bone-implant interface. This paper presents a novel insertability metric designed to efficiently assess whether a rigid body can be inserted into a tight-fitting cavity, without interference. In contrast to existing solutions, the metric is fully differentiable and can be incorporated as a design constraint into shape optimization routines. By exploiting the tight-fitting condition, the problem of planning an interference-free insertion path is reformulated as the search for a single interference-free movement, starting from the inserted configuration. We prove that if there exists any outward movement for which no interference is indicated, then the body can be fully extracted from or, equivalently, inserted into the cavity. This formulation is extremely efficient and highly robust with respect to the complexity of the geometry. We demonstrate the effectiveness and efficiency of our method by applying it to the optimization of two-dimensional (2D) and three-dimensional (3D) designs for insertability, subject to various design requirements. We then incorporate the proposed metric into the optimization of an acetabular cup used in total hip replacement (THR) surgery where geometric and structural requirements are considered.