This is a systematic review comparing incus transposition (IT) and partial ossicular replacement prosthesis (PORP). There is a total of 14 articles, obtaining 1055 patients: 614 for the IT group and 441 for the PORP group. All included patients had a defect of the long process of the incus which is one of the most frequent causes of ossicular discontinuity. Preoperative ABG, postoperative ABG, dB gain and ABG closure rate were compared. Hearing results were based on a 3-12-month postoperative audiogram, differing in various included patients undergoing tympanoplasty with or without mastoidectomy with a canal wall up or canal wall down mastoidectomy. Patients with intact stapes only were included and no difference between transcanal or post-auricular approach was made. The IT group had an ABG closure rate of 64.48%: the PORP group had an ABG closure rate of 71.32%. No significant difference was found in dB mean gain between groups (p > .05), although a difference was found in the ABG closure rate between groups favouring PORP series (p < 0.05). However, this was not statistically significant. The major limitation of this review with which most otologists would agree, was that a postoperative comparison in hearing after five years would be more indicative of a difference in benefit. There was no sub-group analysis with the type of surgical technique, surgical experience, graft material, sculpting technique of incus or prosthetic material (PORP) utilised.