Acetabular Revision with Structural Allograft and Cemented Acetabular Component: A Retrospective Case Series of 13 Patients

Abstract Background Acetabular bone defects remain a challenging problem in revision total hip arthroplasty (THA). Structural allografts can restore the native hip center of rotation and replenish bone stock for potential future revisions, offering a cost-effective alternative in settings with limited access to porous metal augments. This study aimed to evaluate the short- to mid-term clinical and radiographic outcomes of acetabular revisions using structural homologous bone block grafts combined with cemented acetabular components. Methods We retrospectively reviewed 13 consecutive patients (13 hips) with Paprosky type 2B, 2C, 3A, or 3B acetabular defects who underwent revision THA between February 2016 and October 2021. All cases were reconstructed using a structural homologous bone block graft, fixed to the ilium with screws, and a cemented polyethylene acetabular cup. Harris Hip Score (HHS) and standardized radiographs were assessed at the last follow-up. Implant survival and graft origin were analyzed using Kaplan–Meier curves and the log-rank test. Results The mean patient age was 67.3 years (range, 44–85), and the mean follow-up was 54 months (range, 19–88). Two patients (15.4%) experienced reconstruction failure due to graft fragmentation and cup migration. The remaining 11 cases demonstrated satisfactory clinical and radiographic outcomes, with evidence of graft integration and no radiographic signs of loosening. Mean HHS improved from 34.5 ± 7.0 preoperatively to 70.1 ± 10.3 postoperatively. Conclusion Structural allograft with a cemented acetabular component provided good short- to mid-term functional outcomes and radiographic stability in most patients. This technique remains a valuable, lower-cost option for managing major acetabular defects in resource-limited settings. Level of evidence : IV, retrospective case series.