The outcomes of acetabular impaction bone grafting using allografts in uncemented cups for acetabular bone loss: a systematic review and meta-analysis.

Abstract

Purpose: Acetabular bone loss poses a significant challenge in total hip arthroplasty (THA), especially during revision procedures. Impaction bone grafting (IBG) using allografts with uncemented cups is established as a biological reconstruction technique which aims to restore bone stock and achieve a stable fixation. However, there are inconsistent reports regarding its outcomes. This systematic review and meta-analysis aimed to evaluate the clinical and functional outcomes of IBG with uncemented cups in acetabular bone loss.

Methods: A comprehensive literature search of five databases: PubMed, Embase, CINAHL, Cochrane, and Web of Science was completed. Studies reporting functional outcomes and/or complications of IBG in uncemented THA were included. 20 studies, all observational, involving 1166 THAs in 1122 patients met prespecified inclusion criteria. A meta-analysis was conducted for these outcomes, and heterogeneity was assessed.

Results: Meta-analysis revealed significant improvement in mean Harris Hip Score (HHS) of 41.51 (95% CI: 35.71-47.30). Pooled complication rates were low: aseptic loosening (7%; 95% CI: 4%-13%), infection (4%; 95% CI: 3%-5%), need for revision (9%; 95% CI: 6%-14%), and mortality (4%; 95% CI: 2%-11%). There was considerable heterogeneity in the results, reflecting methodological variation across studies.

Conclusions: IBG with uncemented cups suggests meaningful functional improvement and generally acceptable complication rates in managing acetabular bone loss, particularly in revision THA. However, the current evidence base is limited by risk of bias, high heterogeneity, observational study designs, and lack of defect stratification. Future studies should focus on randomised controlled trials to better optimise surgical decision-making.