SynthesisJournal of orthopaedic surgery and research2023
Comparative analysis of surgical interventions for osteonecrosis of the femoral head: a network meta-analysis of randomized controlled trials.
Synthesis in Journal of orthopaedic surgery and research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 5 citations in OpenAlex.
- Diagnosis and Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analyses for the ARCO Clinical Practice Guideline Development Workgroup.Medical sciences (Basel, Switzerland) · 2026Pooled it
- Comparative efficacy and safety of core decompression, cell-based therapy, hyperbaric oxygen therapy, extracorporeal shock wave therapy, and combined regimens for osteonecrosis of the femoral head: a network meta-analysis.Frontiers in cell and developmental biology · 2026Pooled it
- Osteonecrosis of the Femoral Head: Evolution of Contemporary Management Strategies.Current reviews in musculoskeletal medicine · 2026Review
- Clinical applications and cadaveric study of the free descending genicular artery perforator flap without the saphenous vein.BMC surgery · 2024Article
- 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
- Hip Decompression with Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Injection for Osteonecrosis of the Femoral Head.JBJS essential surgical techniquesArticle
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundDespite several surgical options, there remains no consensus regarding the optimal approach for osteonecrosis of the femoral head (ONFH), a prevalent and refractory disease. To determine the most suitable treatment modality, we compared randomized controlled trials (RCTs) that evaluated multiple surgical treatments for ONFH using a Bayesian network meta-analysis (NMA).
methodsThe outcomes of 11 different surgical treatments were assessed using NMA comparisons of the rate of progression of femoral head necrosis, the rate of conversion to total hip arthroplasty, and improvement of the Harris hip score (HHS). A random effects model was used to analyze the odds ratio (OR) or mean difference, and risk of bias was assessed using the Cochrane risk of bias assessment tool for randomized trials. The confidence of the results was assessed using the confidence in network meta-analysis tool.
resultsA total of 18 RCTs were included in the meta-analysis. Compared with core decompression (CD), the forest plot showed that autologous bone grafting (ABG), free fibula grafting (FFG), vascularized bone grafting (VBG), autologous bone grafting combined with bone marrow aspirate concentrate (ABG + BMAC), and biomaterial grafting combined with vascularized bone grafting (BMG + VBG) delayed ONFH progression. Among them, ABG + BMAC showed the most promising results (OR 0.019; 95% confidence interval [CI] 0.0012-0.25). However, upon comparing CD with different surgical modalities, no significant differences were found in preventing total hip arthroplasty. Furthermore, we cannot draw conclusions regarding the HHS due to attribution and high heterogeneity across the studies.
conclusionOverall, ABG, VBG, FFG, ABG + BMAC, and BMG + VBG showed significant results in preventing ONFH progression compared with that shown by CD. Based on the surface under the cumulative ranking, ABG + BMAC was the most effective. Moreover, all treatments involving bone grafting were found to be effective, possibly indicating the necessity of its use in the treatment of ONFH.
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Registered trials
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