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This systematic review and meta-analysis evaluated graft incorporation and cup migration following acetabular impaction bone grafting (IBG) in 1093 hips undergoing revision total hip arthroplasty (rTHA). The pooled graft incorporation rate was 89% at a weighted follow-up of 8 years, while mean lateral and superior cup migration were 2.4 mm and 4.2 mm, respectively, with greater lateral migration observed in cohorts with longer follow-up. The authors conclude that while IBG demonstrates acceptable mid- to long-term graft incorporation, cup migration occurs and warrants structured radiographic follow-up.
Acetabular impaction bone grafting in revision THA demonstrates acceptable graft incorporation, but surgeons should be aware of potential cup migration, particularly in the cranial direction, which may increase over time.
Background Acetabular impaction bone grafting (IBG) is used to address bone loss in revision total hip arthroplasty (rTHA). We evaluated graft incorporation and cup migration after acetabular IBG in rTHA. Methods Systematic search of MEDLINE, EMBASE, and Scopus from inception to June 30, 2024 (PROSPERO CRD42024557047). Studies of acetabular IBG in rTHA with ≥12-month follow-up were included. Outcomes were graft incorporation and horizontal (i.e., lateral to medial axis) and vertical cup migration. Prespecified subgroup analyses assessed bone-loss severity, graft type, additional fixation, and age. Random-effects meta-analyses were used; heterogeneity was quantified with I2. Risk of bias was assessed with the Methodological Index for Non-Randomized Studies. Results Nineteen studies (1093 hips) were included; weighted follow-up was 8.0 years (range 2.0-16.9). Pooled graft incorporation was 89% (95% CI [confidence interval] 79-96; I2 85%). Mean lateral migration was 2.4 mm (95% CI 0.53-4.27) and mean superior migration 4.2 mm (95% CI 1.61-6.75); heterogeneity was high (I2 100% for both). Lateral migration was greater in cohorts with ≥5 years’ follow-up than <5 years (3.65 vs 1.16 mm; P = .018). No significant differences in incorporation were detected by bone-loss severity, graft type, or age; however, subgroup analyses were frequently underpowered and exploratory. Conclusions Acetabular IBG can achieve mid- to long-term graft incorporation of 89%, but estimates are imprecise due to heterogeneous (I2 = 85%), predominantly retrospective evidence. Migration occurs—most commonly cranial—and may accrue over time; values often remain within commonly accepted surveillance thresholds but warrant structured radiographic follow-up. Given high heterogeneity, variable outcome definitions, and potential small-study/publication bias, recommendations should be interpreted cautiously.
