Survivorship and complication rates of osteochondral autografting for isolated femoral head lesions: a systematic review and meta-analysis

Osteochondral autografting is an emerging hip-preservation procedure used to treat femoral head lesions in young patients for whom total hip arthroplasty (THA) is undesirable. However, current evidence remains limited. This systematic review evaluates the survivorship, complication profile, and clinical outcomes following femoral head osteochondral autografting. A systematic review of studies reporting outcomes following femoral head osteochondral autografting was conducted in November 2025 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Comprehensive searches of PubMed, Excerpta Medica database (EMBASE), Cochrane CENTRAL, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science databases were performed. No restrictions on language, study design, or sample size were applied. Survivorship to THA, complications, reoperations, and patient-reported outcome measures (PROMs) were extracted. Thirty-four studies involving 138 patients were included. Survivorship of femoral head osteochondral autografting was 98.5% at 1 year, 94.2% at 3 years, 92.0% at 5 years, and 89.1% at 10 years. The overall complication rate was 27.5% (95% Confidence Interval [CI]: [19.3%, 35.6%]; I2 = 36.8%), with radiographic osteoarthritis being the most common complication (n = 13; 9.42%). Excluding conversion to THA, reoperations were infrequent (n = 13; 8.80%). PROMs demonstrated improvements postoperatively, with pooled mean Harris Hip Scores increasing from 56.17 (95% CI: [48.55, 63.79]; I2 = 98.17%) preoperatively to 89.92 (95% CI: [86.78, 93.05]; I2 = 86.1%) at final follow-up. Femoral head osteochondral autografting demonstrates symptom improvement with promising mid- to long-term survivorship. Although the complication rate approached 30%, most were radiological findings. This suggests osteochondral autografting may be a viable hip-preserving procedure for young patients with femoral head lesions, potentially delaying or eliminating the need for THA.