Evidence map›Paper›PMID 41222718›Full record

SynthesisArchives of orthopaedic and trauma surgery2025

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

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

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Artsiom KlimkoUniversity Hospital Balgrist, Zurich, Switzerland.
Octavian AndronicUniversity Hospital Balgrist, Zurich, Switzerland. Octavian.Andronic@balgrist.ch.
Victor Yan Zhe LuThe Chinese University of Hong Kong, Hong Kong, China.
Dimitris DimitriouUniversity Hospital Balgrist, Zurich, Switzerland.
Armando HochUniversity Hospital Balgrist, Zurich, Switzerland.
Patrick O ZinggUniversity Hospital Balgrist, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFemoral 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.

methodsA 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

resultsA 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).

conclusionsFemoral 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.

Indexed as

Arthroplasty, Replacement, HipBone TransplantationFemurHip ProsthesisReoperationAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedProsthesis FailureBone lossCortical repairFemoral impaction bone graftingGraft incorporationRevision hip arthroplastyStem subsidenceTrabecular incorporationTrabecular remodeling

Identifiers

PMID41222718
PMCPMC12611990

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.