Abstract
Femoral impaction bone grafting is a crucial technique in revision hip arthroplasty, addressing bone loss and ensuring implant stability. The choice between cemented and uncemented stems significantly influences the outcomes and long-term success of the procedure. This systematic review aims to compare the clinical outcomes of cemented versus uncemented stems in femoral impaction bone grafting. A comprehensive search of PubMed, MEDLINE Complete, and the Cochrane Library databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of femoral impaction bone grafting with cemented or uncemented stems were included. The primary outcome measured was the rate of loosening of the femoral component, while secondary outcomes included the incidence of complications such as dislocation, infection, fractures, overall patient mortality, and cardiopulmonary diseases. The literature search yielded 78 articles, with 36 meeting the inclusion criteria. These included one randomized controlled trial, 16 cohort studies (10 retrospective and six prospective), and 15 case series. Most surgeries were revision procedures, with aseptic loosening being the most common indication. For the cemented technique, 1,588 hips were analyzed, with 8.00% experiencing aseptic loosening, 3.53% dislocation, 3.87% infection, 37.33% mortality, 7.57% fractures, and 1.13% cardiopulmonary complications. For the uncemented technique, 464 hips were analyzed, with 1.72% aseptic loosening, 4.74% dislocation, 1.5% infection, 38.47% mortality, 7.76% fractures, and 0.65% cardiopulmonary complications. This systematic review highlights that both cemented and uncemented techniques for femoral impaction bone grafting offer unique benefits and challenges, with the choice depending on patient-specific factors. The uncemented technique, with a lower risk of femoral component loosening, may be better suited for younger, active patients with good bone quality, despite a slightly higher risk of fractures and dislocations. In contrast, the cemented technique, offering immediate stability, is more appropriate for elderly patients with compromised bone quality but carries a higher risk of loosening and cardiopulmonary complications. The decision should be tailored to the patient's clinical profile, including age, bone quality, comorbidities, and the surgeon's expertise.