ArticleInternational orthopaedics2018
No differences in the efficacy among various core decompression modalities and non-operative treatment: a network meta-analysis.
Article in International orthopaedics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Regenerative therapies for femoral head necrosis in the past two decades: a systematic review and network meta-analysis.Stem cell research & therapy · 2024Pooled it
- What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?International orthopaedics · 2021Pooled it
- Efficacy and Safety of Stem Cell Combination Therapy for Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analysis.Journal of healthcare engineering · 2021Pooled it
- Ozone therapy in femoral head necrosis: a perspective on biomarker-guided treatment rationalization and mechanistic exploration.Frontiers in medicine · 2026Article
- Association of the systemic immune inflammation index with failure after core decompression for osteonecrosis of the femoral head: a prospective time-to-event analysis.Annals of medicine · 2025Article
- Osteonecrosis following Steroid Therapy in COVID-19 Patients: An Outlook on the Emerging Problem.Hip & pelvis · 2025Review
- Efficacy of small-diameter core decompression with platelet-rich plasma in early osteonecrosis of the femoral head: a retrospective study.BMC musculoskeletal disorders · 2025Article
- Article
- The efficacy of core decompression combined with regenerative therapy in early femoral head necrosis: a systematic review and meta-analysis involving 954 subjects.Frontiers in pharmacology · 2024Review
- Updating Osteonecrosis of the Femoral Head.Hip & pelvis · 2023Review
- Trends in Surgical Treatment of Femoral Head Osteonecrosis in South Korea: An Analysis Using Nationwide Claims Database.Clinics in orthopedic surgery · 2022Article
- Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis.Journal of orthopaedic surgery and research · 2021Article
- Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment.Journal of Korean medical science · 2021Review
- Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course.BMC musculoskeletal disorders · 2021Article
- Difference in Therapeutic Strategies for Joint-Preserving Surgery for Non-Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature.Orthopaedic surgery · 2021Review
- ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head.Journal of Korean medical science · 2021Review
- CORR Insights®: Did Osteoblastic Cell Therapy Improve the Prognosis of Pre-fracture Osteonecrosis of the Femoral Head? A Randomized Controlled Trial.Clinical orthopaedics and related research · 2020Article
- What are the outcomes of core decompression in patients with avascular necrosis? Protocol for a systematic review.F1000Research · 2020Article
- Classification of osteonecrosis of the femoral head: Who should have surgery?Bone & joint research · 2019Article
- Quality of publications in "International Orthopaedics" and projects for the near future.International orthopaedics · 2018Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCore decompression (CD) has been used to treat early-stage (pre-collapse) osteonecrosis of the femoral head (ONFH) in an attempt to prevent collapse. Recently, other adjunctive treatments including bone grafting (BG) and bone marrow mononuclear cells (BMMC) were combined to traditional CD to improve the results. We assessed the efficacy of various CD modalities and non-operative treatment through a network meta-analysis (NMA).
methodsNine randomized controlled trials with a minimum two year follow-up were retrieved from PubMed, Embase, and Cochrane Library search. Treatment modalities categorized into five; (1) traditional CD alone, (2) CD combining BG, (3) CD combining BMMC, (4) CD combining BG and BMMC, and (5) non-operative treatment. The rate of conversion to total hip arthroplasty (THA) and the radiologic progression were compared among the five treatments.
resultsA total of 453 hips were included in our NMA; 151 hips in CD, 70 hips in CD combining BG, 116 hips in CD combining BMMC, 25 hips in CD combining BG and BMMC, and 91 hips in non-operative treatment. There were no differences in the rate of THA conversion across all five treatment modalities. The pooled risk ratio compared with non-operative treatment for THA conversion was 0.92 (95% CI, 0.19-4.43; p = 0.915) in traditional CD; 4.10 (95% CI, 0.37-45.42; p = 0.250) in CD combining BG; 0.30 (95% CI, 0.04-2.49; p = 0.267) in CD combining BMMC; and 1.78 (95% CI, 0.05-63.34; p = 0.750) in CD combining BG and BMMC. No significant differences were found in terms of the radiologic progression across all treatments.
conclusionsIn the current NMA, we did not find any differences in the rates of THA conversion and radiologic progression across all CD modalities and non-operative treatment. These results question the assumption that CD changes the natural course of ONFH. Considering that size of necrotic portion is the major determinant of future collapse of the necrotic femoral head and the collapse does not occur in small lesions even without any treatment, a large-scale randomized controlled trial is necessary to confirm the effectiveness of CD. LEVEL OF EVIDENCE: Level I, meta-analysis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.