Prognostic factors in the management of osteonecrosis of the femoral head: A systematic review.

Abstract

BACKGROUND:

Several hip preserving techniques have been described for the management of osteonecrosis of the femoral head (ONFH). This systematic review identified prognostic factors in the treatment of ONFH that are associated with treatment failure and conversion to total hip arthroplasty (THA).

MATERIAL AND METHODS:

This study followed the PRISMA guidelines. The literature search was conducted in November 2021. All clinical trials comparing two or more treatments for femoral head osteonecrosis were accessed. A multivariate analysis was performed to investigate the association between baseline characteristics and the surgical outcome. A multiple linear model regression analysis through the Pearson Product-Moment Correlation Coefficient (r) was used.

RESULTS:

Data from 88 articles (6112 procedures) were retrieved. Female gender was associated with increased time to THA (P = 0.03) and reduced rate of THA (P = 0.03). Longer symptom duration before treatment was associated with shorter time to failure (P = 0.03). Increased pre-treatment VAS was associated with reduced time to failure (P = 0.03) and time to THA (P = 0.04). Reduced pre-treatment hip function was associated with increased rate of THA (P = 0.02) and failure (P = 0.005). Patient age and BMI, aetiology, time from surgery to full weight bearing and the side did not show evidence of a statistically significant association with the surgical outcome.

CONCLUSION:

Male gender, longer symptom duration before treatment, higher VAS scores, and lower HHS scores were negative prognostic factors after treatment for osteonecrosis of the femoral head.

• Authors: Filippo Migliorini, Nicola Maffulli, Alice Baroncini, Jörg Eschweiler, Markus Tingart, Marcel Betsch
• Journal: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland (Surgeon) Vol. 21 Issue 2 Pg. 85-98 (Apr 2023) ISSN: 1479-666X [Print] Scotland
• PMID: 34991986 (Publication Type: Journal Article, Systematic Review)
• Copyright: Copyright © 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Female
• Humans
• Male
• Arthroplasty, Replacement, Hip
• Femur Head Necrosis (surgery, therapy)
• Linear Models
• Multivariate Analysis
• Prognosis
• Risk Factors
• Sex Factors
• Time Factors
• Treatment Outcome