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Purpose <p>To evaluate the incidence of surgical complications, particularly periprosthetic fractures, following femoral impaction bone grafting (fIBG) in revision total hip arthroplasty (rTHA).</p> Methods <p>This systematic review followed PRISMA guidelines. Studies reporting on fIBG in rTHA with a minimum follow-up of 12&#xa0;months were included. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS). A random-effects meta-analysis with inverse-variance weighting was performed. Heterogeneity was assessed using Higgins and Thompson’s I<sup>2</sup> statistic and Cochran’s Q test. Subgroup analyses were conducted based on patient characteristics, revision indication, follow-up period, bone loss severity, stem length, and cementation. Complications requiring intervention, as well as nerve lesions with partial or no recovery, were classified as major.</p> Results <p>Forty-five studies including 4,686 hips (4,409 patients) were analyzed. The pooled incidence of major complications was 21% (<i>n</i> = 730; 95% CI 16–26%; I<sup>2</sup> = 89%, <i>p</i> &lt; 0.01). Of these, 78% required surgical intervention. The most common major complications were intraoperative fractures (22.7%), postoperative fractures (19.3%), and instability (19.2%). Higher complication rates were reported with long stems (44.1%) compared with short stems (18.8%, <i>p</i> = 0.016) and in cases of severe bone loss (Endo-Klinik grades III/IV, 25.3%) compared with I/II (14.2%, <i>p</i> = 0.028).</p> Conclusion <p>Major complications following fIBG in rTHA are relatively frequent, although interpretation is limited by substantial study heterogeneity. Higher complication rates were observed in cases with severe bone loss and the use of long stems, likely reflecting greater surgical complexity.</p>

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Surgical complications and periprosthetic fractures following femoral impaction grafting in revision hip arthroplasty: a systematic review and meta-analysis of 4686 hips

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Octavian Andronic,
  • Rutenis Badikonis,
  • Artsiom Klimko,
  • Victor Yan Zhe Lu,
  • Armando Hoch,
  • Patrick O. Zingg

摘要

Purpose

To evaluate the incidence of surgical complications, particularly periprosthetic fractures, following femoral impaction bone grafting (fIBG) in revision total hip arthroplasty (rTHA).

Methods

This systematic review followed PRISMA guidelines. Studies reporting on fIBG in rTHA with a minimum follow-up of 12 months were included. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS). A random-effects meta-analysis with inverse-variance weighting was performed. Heterogeneity was assessed using Higgins and Thompson’s I2 statistic and Cochran’s Q test. Subgroup analyses were conducted based on patient characteristics, revision indication, follow-up period, bone loss severity, stem length, and cementation. Complications requiring intervention, as well as nerve lesions with partial or no recovery, were classified as major.

Results

Forty-five studies including 4,686 hips (4,409 patients) were analyzed. The pooled incidence of major complications was 21% (n = 730; 95% CI 16–26%; I2 = 89%, p < 0.01). Of these, 78% required surgical intervention. The most common major complications were intraoperative fractures (22.7%), postoperative fractures (19.3%), and instability (19.2%). Higher complication rates were reported with long stems (44.1%) compared with short stems (18.8%, p = 0.016) and in cases of severe bone loss (Endo-Klinik grades III/IV, 25.3%) compared with I/II (14.2%, p = 0.028).

Conclusion

Major complications following fIBG in rTHA are relatively frequent, although interpretation is limited by substantial study heterogeneity. Higher complication rates were observed in cases with severe bone loss and the use of long stems, likely reflecting greater surgical complexity.