Survivorship and Patient-Reported Outcomes in Femoral Impaction Bone Grafting for Revision Hip Arthroplasty: A Systematic Review and Meta-Analysis of 4,102 Hips.

Abstract

Femoral impaction bone grafting (IBG) is widely used in revision total hip arthroplasty for cases with severe bone loss. The purpose of this systematic review and meta-analysis was to assess survivorship and patient-reported outcome measures (PROMs) following femoral IBG. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on femoral IBG in revision total hip arthroplasty with a minimum follow-up of 12 months were included. A random-effects model and the inverse-variance weighting method were used for meta-analysis. Heterogeneity was assessed using Higgins and Thompson's I² statistic and Cochran's Q test. The systematic search included a total of 45 studies, comprising 4,102 hips in 3,805 patients. The overall 10-year survivorship for femoral IBG was 95% (confidence interval 92 to 97), with significant data heterogeneity (I² = 79%, P < 0.01). Patients who had higher Endo-Klinik (EK) grades of femoral bone loss (III and IV) had significantly lower 10-year survival rates (90.9 versus 97.4% for EK grades I and II, P = 0.048). Neither patient age (≥ 65 years: 94.5 versus < 65 years: 96.6%, P = 0.23) nor stem length (short stems: 95.5 versus long stems: 94.8%, P = 0.86) significantly affected 10-year survival outcomes. PROMs included the Harris Hip Score, which notably improved postsurgery (standardized mean difference: 10.7, 95% confidence interval: 8.26 to 13.05, I² = 99%). Hip revision arthroplasty with femoral IBG demonstrates high long-term (10-year) survivorship rates (95%, 92 to 97%, I² = 79%) and significant improvements in PROMs, specifically the Harris Hip Score (I² = 92%), especially in cases with moderate bone loss (EK stages I and II). There was a lower survivorship (90%) in hips with severe bone defects (EK stages III and IV), regardless of additional fixation.