Work

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

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: 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 I 2 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.

Source: Archives of Orthopaedic and Trauma Surgery

DOI: 10.1007/s00402-025-06122-1

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

Institutions: Universitätsklinik Balgrist, Chinese University of Hong Kong

Language: English

Topic: Orthopaedic implants and arthroplasty

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,590