{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:37Z","timestamp":1790618317336,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Osteonecrosis of the femoral head is a common late complication of allogeneic haematopoietic stem cell transplantation, driven largely by graft-versus-host disease (GVHD) and its immunosuppressive treatment. We evaluated implant survivorship, all-cause revision and periprosthetic joint infection or septic loosening after total hip arthroplasty, and whether GVHD modifies these outcomes. Methods: Six databases were searched from inception to July 2026. The review was registered with PROSPERO (CRD420261446131) and reported per PRISMA 2020. Proportions were pooled with a random-intercept logistic model, with sensitivity analyses for the registered Freeman\u2013Tukey approach, follow-up duration, within-patient clustering and competing mortality. Risk of bias used ROBINS-I and MINORS, certainty GRADE; GVHD was the prespecified effect modifier. Results: Six studies were included; four cohorts (228 hips) were pooled. Pooled all-cause revision was 4.39% (95% CI 2.38\u20137.96) and pooled infection or septic loosening 1.05% (95% CI 0.28\u20133.87). In the two cohorts followed beyond five years (182 hips), these rose to 5.49% (95% CI 2.98\u20139.91) and 1.62% (95% CI 0.51\u20135.01), the two shorter cohorts recording no event in 46 hips. All three infection events arose in one cohort, in patients with chronic GVHD on steroids at revision. With no GVHD-stratified denominators reported, however, this remains descriptive, not an estimable relative risk. Certainty was very low throughout. Conclusions: Total hip arthroplasty after allogeneic transplantation is durable over the first post-operative decade. All infection-related failures arose in patients with chronic GVHD on continuing immunosuppression\u2014a mechanistically plausible pattern, but one resting on three events in one cohort and still unquantified. GVHD-stratified reporting is the next step.<\/jats:p>","DOI":"10.3390\/jcm15197528","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7528","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Total Hip Arthroplasty for Osteonecrosis of the Femoral Head Following Allogeneic Haematopoietic Stem Cell Transplantation, with Graft-Versus-Host Disease as a Candidate Effect Modifier: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Minki","family":"Beak","sequence":"first","affiliation":[{"name":"Department of Community Health, Tufts University, Medford, MA 02155, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5648-9755","authenticated-orcid":false,"given":"Young Wook","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s11999-007-0044-z","article-title":"Osteonecrosis after allogeneic bone marrow transplantation","volume":"466","author":"Zadegan","year":"2008","journal-title":"Clin. 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