Osteochondral Allograft or Autograft Transplantation of the Femoral Head Leads to Improvement in Outcomes But Variable Survivorship: A Systematic Review

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Purpose: To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation(OAT) of the femoral head.

Methods: Pubmed, Cochrane Center for Register of Controlled Trials (CENTRAL), and Scopus databases were searched in November 2022 with an updated search extending to December 2023 using criteria from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the following keywords: (hip OR femoral head) AND (mosaicplasty OR osteochondral allograft OR osteochondral autograft OR osteochondral lesion). Articles were included if they evaluated postoperative PROs in patients who underwent OAT of the femoral head and had a study size of five or more hips (n ≥ 5). Survivorship was defined as freedom from conversion to THA. For PROs evaluated in three studies or more, forest plots were created and I2 was calculated.

Results: 12 studies were included in this review with a total of 156 hips and an average follow-up time ranging between 16.8 months and 222 months. 104(66.7%) hips were male while 52(33.3%) were female. Age of patients ranged from 17.0 to 35.4 years while BMI ranged from 23.3 to 28.1. Eight studies reported on osteochondral autograft transplantation and four studies on osteochondral allograft transplantation. Three studies reported significant improvement in at least one PRO. Survivorship ranged from 61.5% to 96% at minimum two-year follow-up and from 57.1% to 91% at minimum five-year follow-up. At follow-up of less than five years, osteochondral allograft transplantation studies showed 70% to 87.5% survivorship, while autograft varied from 61.54% to 96%.

Conclusion: Patients with osteochondral lesions of the femoral head who underwent osteochondral autograft or allograft transplantation demonstrated improved patient-reported outcomes but variable survivorship rates.

Study design: Systematic Review of Level IV studies, Level of Evidence IV.



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OAT, Osteochondral autograft transplantation, femoral head osteochondral allograft transplantation