Use of morselized bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis.

Purpose: Many treatment options are available for the revision of large acetabular defects. Debate continues as to which technique is most effective. This meta-analysis aimed to determine the rates of failure of acetabular bone defects Paprosky type III or American Academy of Orthopaedic types III-IV treated with morselized allograft in association with cemented cup or cementless cup or reinforcement devices. Methods: The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to 1 April 2024 utilizing keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting and revision THA. The main outcome measure was the 9-year implant failure rate. Results: Thirty-nine articles were eligible for inclusion in the current study. We found 41 treatment approaches that we grouped into three different treatment options: 1 = morselized allograft and cemented cup (10 studies); 2 =morselized allograft and cementless cup (nine studies); 3 = morselized allograft and device (22 studies). The overall implant failure rate was 2.1% (95% confidence interval [CI], 1.6%-2.8%) at a mean of 9.2 years. There was no significant difference in failure rates between different treatment options (1.6% [95% CI, 0.9%-2.6%]) for morselized allograft and cemented cup; 2.1% (95% CI, 1.4%-3.2%) for morselized allograft and cementless cup; 2.5% (95% CI, 1.7%-3.7%) for morselized allograft and device) between the three different types of treatment (heterogeneity between groups Conclusions: The use of morselized allograft in hip revision of large acetabular defects has low implant failure rates, independently of the associated type of implant. Reinforcement devices increase the risk of re-revision for infection and dislocation. Level of Evidence: Level III.