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Background <p>Femoral impaction bone grafting (IBG) is an established technique for managing severe bone loss during revision total hip arthroplasty (rTHA). Despite its widespread use, the extent of graft incorporation and the degree of stem subsidence remain incompletely characterized. This systematic review evaluates graft incorporation and stem subsidence outcomes in femoral IBG for rTHA.</p> Methods <p>A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta–Analyses) guidelines. Three databases were searched from inception to December 31, 2024, for studies involving rTHA with femoral IBG and a minimum follow–up of 12&#xa0;months. Meta–analyses focused on graft incorporation rates and stem subsidence. Subgroup analysis examined age, pre–operative bone loss, graft type, follow–up duration and other predictors. Heterogeneity was assessed using the I<sup>2</sup> statistic under a random–effects model.</p> Results <p>A total of 33 studies (2395 patients; 2514 hips) met inclusion criteria. The mean patient age was 66&#xa0;years (range 22–95&#xa0;years), with a male–to–female distribution of 48%/52%. The hips–weighted mean follow–up was 8.8&#xa0;years (range of study means 1.1–17.0&#xa0;years). Overall, the pooled proportion of graft incorporation was 76%; 95% confidence interval (CI) 63%–85%. The weighted average subsidence across all studies was 2.5&#xa0;mm (95% CI 1.7–3.1&#xa0;mm). Subgroup analyses showed no statistically significant differences in graft incorporation rates based on graft type (<i>p</i> = 0.399), age (<i>p</i> = 0.742), or follow–up duration (<i>p</i> = 0.560). Similarly, stem subsidence did not differ significantly by gender (<i>p</i> = 0.181), graft type (<i>p</i> = 0.460), or age (<i>p</i> = 0.301). Preoperative bone loss classification (Endo–Klinik, Paprosky) was not associated with notable differences in graft incorporation (<i>p</i> = 0.263) or subsidence (<i>p</i> = 0.486).</p> Conclusions <p>Femoral IBG for rTHA demonstrates variable but generally favorable graft incorporation rates, averaging 76% (95% CI 63%–85%), with a mean stem subsidence of 2.5&#xa0;mm at mid–to–long–term follow–up. Neither graft type, stem design, age, nor preoperative bone loss classification significantly influenced subsidence or incorporation variability.</p>

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Graft incorporation and stem subsidence in femoral impaction bone grafting for revision hip arthroplasty: a systematic review and meta–analysis of 2514 hips

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  • 发表日期：

    2025年11月12日

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

摘要

Background

Femoral impaction bone grafting (IBG) is an established technique for managing severe bone loss during revision total hip arthroplasty (rTHA). Despite its widespread use, the extent of graft incorporation and the degree of stem subsidence remain incompletely characterized. This systematic review evaluates graft incorporation and stem subsidence outcomes in femoral IBG for rTHA.

Methods

A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta–Analyses) guidelines. Three databases were searched from inception to December 31, 2024, for studies involving rTHA with femoral IBG and a minimum follow–up of 12 months. Meta–analyses focused on graft incorporation rates and stem subsidence. Subgroup analysis examined age, pre–operative bone loss, graft type, follow–up duration and other predictors. Heterogeneity was assessed using the I2 statistic under a random–effects model.

Results

A total of 33 studies (2395 patients; 2514 hips) met inclusion criteria. The mean patient age was 66 years (range 22–95 years), with a male–to–female distribution of 48%/52%. The hips–weighted mean follow–up was 8.8 years (range of study means 1.1–17.0 years). Overall, the pooled proportion of graft incorporation was 76%; 95% confidence interval (CI) 63%–85%. The weighted average subsidence across all studies was 2.5 mm (95% CI 1.7–3.1 mm). Subgroup analyses showed no statistically significant differences in graft incorporation rates based on graft type (p = 0.399), age (p = 0.742), or follow–up duration (p = 0.560). Similarly, stem subsidence did not differ significantly by gender (p = 0.181), graft type (p = 0.460), or age (p = 0.301). Preoperative bone loss classification (Endo–Klinik, Paprosky) was not associated with notable differences in graft incorporation (p = 0.263) or subsidence (p = 0.486).

Conclusions

Femoral IBG for rTHA demonstrates variable but generally favorable graft incorporation rates, averaging 76% (95% CI 63%–85%), with a mean stem subsidence of 2.5 mm at mid–to–long–term follow–up. Neither graft type, stem design, age, nor preoperative bone loss classification significantly influenced subsidence or incorporation variability.