Automated impaction in uncemented total hip arthroplasty: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Aims
Intraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA.
Methods
We performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs.
Results
Comparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (−1.34 minutes; 95% CI −15.60 to 12.92; p = 0.72).
Conclusion
Automated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component–femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.
Intraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA.
Methods
We performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs.
Results
Comparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (−1.34 minutes; 95% CI −15.60 to 12.92; p = 0.72).
Conclusion
Automated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component–femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.
Date Issued
2026-07-02
Date Acceptance
2026-03-29
Citation
Bone & Joint Open, 2026, 7 (7), pp.838-844
ISSN
2633-1462
Publisher
The British Editorial Society of Bone & Joint Surgery
Start Page
838
End Page
844
Journal / Book Title
Bone & Joint Open
Volume
7
Issue
7
Copyright Statement
© 2026 Brkljac et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
10.1302/2633-1462
Publication Status
Published