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

Migliorini, Filippo; Maffulli, Nicola; Baroncini, Alice; Eschweiler, Jörg; Tingart, Markus; Betsch, Marcel

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.

Citation

Migliorini, F., Maffulli, N., Baroncini, A., Eschweiler, J., Tingart, M., & Betsch, M. (2023). Prognostic factors in the management of osteonecrosis of the femoral head: A systematic review. Surgeon, 21(2), 85-98. https://doi.org/10.1016/j.surge.2021.12.004

• Journal Article Type: Article
• Acceptance Date: Dec 9, 2021
• Online Publication Date: Jan 4, 2022
• Publication Date: 2023-04
• Deposit Date: Jan 30, 2024
• Journal: The Surgeon
• Print ISSN: 1479-666X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 2
• Pages: 85-98
• DOI: https://doi.org/10.1016/j.surge.2021.12.004
• Keywords: Surgery
• Additional Information: This article is maintained by: Elsevier; Article Title: Prognostic factors in the management of osteonecrosis of the femoral head: A systematic review; Journal Title: The Surgeon; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.surge.2021.12.004; Content Type: article; 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.