Optimisation of Metal Augments in Revision Total Hip Arthroplasty: Current Advances and Future Directions

Revision total hip arthroplasty (THA) is a challenging procedure, especially when addressing acetabular bone defects that compromise implant stability and long-term fixation. Metal augmentation is a common solution to restore structural integrity and ease implant placement. Recent literature has increasingly addressed clinical outcomes, porous implant technologies, and patient-specific reconstruction; however, an integrated perspective linking defect morphology, implant design, biomechanics, computational optimisation, manufacturing, and clinical translation remains limited. This narrative review critically discusses current metal augmentation technologies in terms of biomechanical performance, defect characteristics, and clinical outcomes. The main limitations, such as poor geometrical conformity, stress shielding, micromotion, and fixation failure, are discussed along with the role of computational modelling in evaluating implant behaviour. Critically, the review highlights the lack of integrated frameworks linking defect morphology, biomechanical performance, and clinical outcomes. Emerging technologies like additive manufacturing, patient-specific implants, and digital modelling are discussed from a translational perspective. It also emphasises the need for clinically validated, biomechanics-driven evaluation strategies to guide acetabular reconstruction and improve patient outcomes in revision THA.