Two-stage Acetabular Impaction Bone Grafting: A Case Report

Restoring bone loss in revision Total Hip Arthroplasty (THA) surgery is challenging. Acetabular impaction bone grafting (AIBG) allows the restoration of bone stock and normal hip biomechanics. AIBG is usually performed as a single-stage surgery with hip component implantation, as it is traditionally believed that adequate loading of the impacted graft is necessary for integration with the host bone thus preventing bone resorption. We present a case of a 73-year-old gentleman who presented with bilateral hip pain and reduced mobility. He was diagnosed with left THA aseptic loosening with acetabular protrusion and subsequently underwent a two-stage AIBG using irradiated femoral head allografts. The first stage was performed without acetabular loading, yet the allograft successfully integrated with the host bone. This is the first reported case of a two-stage AIBG demonstrating that acetabular loading may not be required for allograft integration to host bone. Therefore, AIBG may be performed as a two-stage procedure, when necessary, especially in the setting of complex revision hip surgeries and patients with poor bone stock.