Abstract / Summary
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–Tukey 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 2.38–7.96) and pooled infection or septic loosening 1.05% (95% CI 0.28–3.87). In the two cohorts followed beyond five years (182 hips), these rose to 5.49% (95% CI 2.98–9.91) and 1.62% (95% CI 0.51–5.01), 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—a mechanistically plausible pattern, but one resting on three events in one cohort and still unquantified. GVHD-stratified reporting is the next step.