髋关节翻修术中股骨嵌压植骨的生存率及患者报告结局：对4102例髋关节的系统评价和荟萃分析
Survivorship and Patient-Reported Outcomes in Femoral Impaction Bone Grafting for Revision Hip Arthroplasty: A Systematic Review and Meta-Analysis of 4,102 Hips.
作者信息
Klimko Artsiom, Andronic Octavian, Lu Victor Yan Zhe, Dimitriou Dimitris, Hoch Armando, Zingg Patrick O
机构信息
Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Sha Tin, Hong Kong, China.
出版信息
J Arthroplasty. 2025 Jul 3. doi: 10.1016/j.arth.2025.06.034.
BACKGROUND
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.
METHODS
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 I statistic and Cochran's Q test.
RESULTS
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 (I = 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, I = 99%).
CONCLUSIONS
Hip revision arthroplasty with femoral IBG demonstrates high long-term (10-year) survivorship rates (95%, 92 to 97%, I = 79%) and significant improvements in PROMs, specifically the Harris Hip Score (I = 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.
背景
股骨打压植骨术（IBG）广泛应用于严重骨量丢失的翻修全髋关节置换术。本系统评价和荟萃分析的目的是评估股骨IBG术后的生存率和患者报告结局指标（PROMs）。
方法
本系统评价遵循系统评价和荟萃分析的首选报告项目指南。纳入报告翻修全髋关节置换术中股骨IBG且随访至少12个月的研究。采用随机效应模型和逆方差加权法进行荟萃分析。使用Higgins和Thompson的I统计量以及Cochran's Q检验评估异质性。
结果
系统检索共纳入45项研究，包括3805例患者的4102髋。股骨IBG的总体10年生存率为95%（置信区间92%至97%），存在显著的数据异质性（I = 79%，P < 0.01）。股骨骨量丢失Endo-Klinik（EK）分级较高（III级和IV级）的患者10年生存率显著较低（EK I级和II级分别为90.9%和97.4%，P = 0.048）。患者年龄（≥65岁：94.5% vs <65岁：96.6%，P = 0.23）和柄长度（短柄：95.5% vs长柄：94.8%，P = 0.86）均未显著影响10年生存结局。PROMs包括Harris髋关节评分，术后显著改善（标准化均数差值：10.7，95%置信区间：8.26至13.05，I = 99%）。
结论
股骨IBG的髋关节翻修置换术显示出较高的长期（10年）生存率（95%，92%至97%，I = 79%），PROMs有显著改善，特别是Harris髋关节评分（I = 92%），尤其是在中度骨量丢失（EK I期和II期）的病例中。严重骨缺损（EK III期和IV期）的髋关节生存率较低（90%），无论是否有额外固定。
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