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Difficulty persists in consistently treating massive acetabular defects in revision total hip arthroplasty. A relatively new treatment option for these complex cases is a custom triflanged acetabular component created from anatomic data derived from a computed tomography scan of the pelvis. The custom triflanged acetabular component achieves fixation on the remaining ilium, ischium, and pubis with multiple fixation screws while the acetabular defect is filled with cancellous allograft bone. A retrospective review was done of 26 hips (26 patients) with massive periacetabular bone loss (Paprosky Type 3B) reconstructed with a custom triflanged acetabular component. Twenty-three of 26 patients (88.5%) were considered clinically successful at short-term followup (average, 54 months; range, 24 to 85 months), with stable fixation and reconstruction of periacetabular bone. Three failures occurred from loss of ischial fixation in two patients with a preoperative pelvic discontinuity and one patient with severe osteopenia. These devices should be used with caution in patients with a preoperative pelvic discontinuity unless additional column plating is done.