Complications Rate and Hip Function After Revision of Infected Hip Arthroplasty with Bone Defects using Bone Allografts: A Systematic Review and Meta-Analysis.

Objectives: We performed a systematic review and meta-analysis to evaluate complication rates and hip function following the revision of infected hip arthroplasty with bone defects using bone allografts. Methods: A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted up to January 2024 to identify pre-post clinical trials. The primary outcomes assessed were the risk of reinfection, a critical concern for surgeons, and hip functional scores. The methodological quality of the included studies was also evaluated. A weighted mean difference (WMD) with a 95% confidence interval (CI) was used as the pooled estimate for clinical outcomes through random-effects meta-analysis, accounting for heterogeneity across studies. Results: Of the 2,189 records retrieved, 12 pre-post clinical trials (with fair to good quality) were included in the meta-analysis, involving a total of 342 participants. The pooled mean difference in Harris Hip Score (HHS) was 36.86 (95% CI: 29.58 to 44.13) post-surgery. In a subgroup analysis of studies employing structural grafts, the HHS increased by 36.99 (95% CI: 29.56 to 44.42). The overall reinfection rate was 6%. Subgroup analysis revealed that in studies utilizing morselized and structural allografts, the reinfection rates were 6% and 3%, respectively. The overall mean rate of aseptic loosening was 5%. Subgroup analysis showed that in studies using morselized grafts, the rate of aseptic loosening was 4%. The incidence of dislocation was 2% in the morselized group and 5% in the structural group. Conclusion: Revision of infected hip arthroplasty with bone defects using bone allografts may improve hip function. Interestingly, morselized allografts are often associated with higher rates of reinfection. Additionally, our findings suggest that structural allografts are associated with increased dislocation rates compared to morselized allografts. This difference may be attributed to the larger and more complex defects that necessitated the use of structural allografts rather than morselized grafts.