Clinical improvement but substantial arthroplasty risk following fresh osteochondral allograft transplantation of the femoral head: A systematic review and single-arm meta-analysis.

PURPOSE: To systematically review the literature and perform a single-arm meta-analysis to evaluate clinical outcomes, failure rates and survivorship following fresh osteochondral allograft transplantation of the femoral head.

METHODS

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Ovid MEDLINE and Scopus. Clinical studies reporting outcomes of fresh osteochondral allograft transplantation of the femoral head with a minimum follow-up of 12 months were included. A single-arm random-effects meta-analysis of proportions was performed to estimate the pooled rate of conversion to total hip arthroplasty.

RESULTS

Eight studies comprising 145 hips were included. The mean patient age ranged from 21 to 26 years, with a mixed sex distribution across studies. Mean follow-up ranged from 17.2 to 79.2 months. Indications were heterogeneous and included osteonecrosis, osteochondritis dissecans, post-traumatic chondral defects and sequelae of Legg-Calvé-Perthes disease. Patient-reported outcomes improved postoperatively across all studies reporting pre- and postoperative data. Individual study failure rates ranged from 17.7% to 37.5% at final follow-up. Pooled analysis using a single-arm random-effects meta-analysis demonstrated an overall conversion rate of 26.7% (95% confidence interval, 20.1%-34.7%), with low heterogeneity (I2 = 0%). Reported survivorship ranged from 68.8% to 93.8% at 2-5 years and approximately 62%-67% at 9-10 years in studies providing long-term data. Overall methodological quality was moderate, with MINORS scores ranging from 10 to 12.

CONCLUSIONS

Fresh osteochondral allograft transplantation of the femoral head is associated with postoperative improvement in patient-reported outcomes and achieves joint preservation in the majority of patients at mid-term follow-up. However, approximately one-quarter of treated hips progressed to total hip arthroplasty during follow-up, indicating that failure remains a clinically relevant risk.

LEVEL OF EVIDENCE: Level IV systematic review.