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: = 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.