Success and Safety of Isolated Cup Revision Arthroplasty: A Systematic Review.

Abstract

Background: Isolated acetabular revision arthroplasty is increasingly performed as the number of primary total hip arthroplasties rises and implant longevity is challenged. Although this procedure avoids the morbidity associated with full-component revision, concerns remain regarding instability, osteolysis, and long-term implant survival. Previous reviews have not specifically synthesized clinical, radiological, and functional results of isolated acetabular revision based on implant type, surgical approach, and patient-related factors. The current review intends to summarize the clinical, radiological, and functional results of isolated acetabular revision surgeries while focusing on the effectiveness of different surgical approaches, implant types, and patient factors used to improve postoperative results.

Methods: A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library was conducted from inception to January 2025. The entire review process adhered to PRISMA 2020 guidelines. Two independent reviewers conducted screening, critical appraisal, and data extraction. Eligibility criteria included adult patients undergoing isolated acetabular revision with a well-fixed femoral stem. Risk of bias was evaluated using RoB-2 for randomized trials and ROBINS-I for observational studies. Narrative synthesis was performed to integrate clinical, radiological, and survival outcomes.

Results: The initial search yielded 1154 records. Twelve studies met the inclusion criteria. Functional outcomes improved significantly (HHS increased from 48-50 to 86-88 across studies). Dislocation rates ranged from 0-7%, with lower rates in dual-mobility cups. Implant survival was 95-98% at 10-15 years. Radiological evaluation demonstrated high rates of osteointegration and low rates of cup loosening among contemporary cementless implants. Long-term survival ranged from 95% to 98% at 10-15 years. Heterogeneity in study design, surgical approach, and implant type was observed, and the overall risk of bias was moderate.

Conclusion: Isolated acetabular revision arthroplasty provides significant functional improvement, reliable radiographic outcomes, and high implant survival when the femoral stem is stable. Modern cementless and dual-mobility components appear to reduce instability and enhance osteointegration. Further well-designed prospective studies with standardized outcome reporting are needed to refine indications and optimize long-term results.