Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review
Michael-Alexander Malahias1, Fabio Mancino1, Alex Gu1
1The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA.
Summary
Impaction bone grafting (IBG) with mesh is effective for acetabular bone defects in selected total hip arthroplasty patients. However, severe lateral defects or superomedial migration may require alternative treatments.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
Background:
- Metal meshes are used with impaction bone grafting (IBG) to manage acetabular bone defects in total hip arthroplasty (THA).
- These meshes aim to convert uncontained defects into contained ones, facilitating IBG.
Purpose of the Study:
- To evaluate the effectiveness of IBG combined with mesh for acetabular bone defects in revision THA.
- To identify patient subgroups and defect types where this combined approach is most suitable.
Main Methods:
- A systematic review of publications from January 1980 to March 2019 was conducted.
- Databases searched included PubMed/MEDLINE, EMBASE, and Cochrane.
- Keywords focused on THA, acetabular IBG, clinical outcomes, and revision surgery.
Main Results:
- Seven articles met inclusion criteria, with a mean methodological score of 45.3.
- Severe acetabular bone loss was present in 56% of cases.
- The all-cause reoperation rate was 7.4%, and the acetabular component revision rate was 6.2%.
Conclusions:
- IBG with mesh is effective for selected acetabular bone defects, particularly moderate bone loss and large superolateral defects.
- Limited data suggests potential decreased survival rates for severe lateral defects requiring combined meshes.
- IBG with mesh is contraindicated for severe superomedial cup migration (Paprosky IIIB).
