Evidence map›Paper›PMID 41892822›Full record

SynthesisMedical sciences (Basel, Switzerland)2026

Diagnosis and Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analyses for the ARCO Clinical Practice Guideline Development Workgroup.

Romil R Parikh, Alireza Mirzaei, Mary E Butler, Diego J Restrepo, Sergio F Guarin Perez, Sallee Brandt, Gabrielle Swartz, Reza Katanbaf, Stuart B Goodman, Michael A Mont and 3 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Medical sciences (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Romil R ParikhMinnesota Evidence-based Practice Center, Division of Health Policy & Management, University of Minnesota, Minneapolis, MN 55455, USA.ORCID 0000-0001-6087-0583
Alireza MirzaeiDepartment of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Mary E ButlerMinnesota Evidence-based Practice Center, Division of Health Policy & Management, University of Minnesota, Minneapolis, MN 55455, USA.
Diego J RestrepoDepartment of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.ORCID 0009-0007-8195-4189
Sergio F Guarin PerezDepartment of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.ORCID 0009-0005-5272-1533
Sallee BrandtMinnesota Evidence-based Practice Center, Division of Health Policy & Management, University of Minnesota, Minneapolis, MN 55455, USA.
Gabrielle SwartzDepartment of Orthopaedic Surgery, Sinai Hospital, LifeBridge Health, Baltimore, MD 21215, USA.
Reza KatanbafDepartment of Orthopaedic Surgery, Sinai Hospital, LifeBridge Health, Baltimore, MD 21215, USA.ORCID 0000-0002-1862-5602
Stuart B GoodmanDepartment of Orthopaedic Surgery, Stanford University, Palo Alto, CA 94063, USA.ORCID 0000-0002-1919-3717
Michael A MontDepartment of Orthopaedic Surgery, Sinai Hospital, LifeBridge Health, Baltimore, MD 21215, USA.
Quanjun CuiDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA.
Lynne C JonesDepartment of Orthopaedic Surgery, Johns Hopkins University, MD 21224, USA.
Edward Y ChengDepartment of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectivesDiagnostic evaluation and management of nontraumatic osteonecrosis of the femoral head (ONFH) vary substantially. This systematic review was conducted to inform development of the Association Research Circulation Osseous (ARCO) clinical practice guideline for diagnosis and treatment of ARCO stages I to III ONFH.

methodsWe searched MEDLINE, EMBASE, Web of Science, SCOPUS, Global Index Medicus, and the Cochrane Library for studies evaluating imaging modalities and treatments for adult ONFH. We assessed risk of bias using the QUADAS-2, the ROB-2, and the ROBINS-I tools; conducted meta-analyses using random-effects regression; and evaluated certainty of evidence using GRADE methodology.

resultsAmong 36 included studies, 18 addressed diagnostic test accuracy and 18 addressed comparative effectiveness of treatments. Magnetic resonance imaging (MRI) demonstrated the highest pooled sensitivity (0.91; 95% confidence interval (CI), 0.87 to 0.94) and specificity (0.96; 95% CI, 0.87 to 0.99) for ONFH diagnosis. Bone marrow edema and grade 2+ joint effusion on MRI differentiated symptomatic versus asymptomatic disease. Computed tomography and MRI better detected subchondral fractures than plain radiography. Very low-grade evidence suggested lower rates of femoral head collapse with core decompression plus bone marrow concentrate compared with core decompression alone (pooled relative risk [RR], 0.55; 95% CI, 0.36 to 0.83), and with vascularized versus non-vascularized bone grafting (RR, 0.35; 95% CI, 0.14 to 0.84) over a ≤5-year follow-up. Based on three non-comparative case series, osteotomies might have a lower risk of collapse over a 10- to 20-year follow-up, but this needs to be evaluated in future comparative research. Inconsistent outcome reporting hindered treatment outcome pooling. There were no comparative studies that evaluated observation only versus intervention in asymptomatic disease or strategies for monitoring treatment response.

conclusionsEvidence supporting optimal imaging modalities and early joint-preserving interventions remains limited and predominantly observational, underscoring the need for high-quality comparative studies with consistently defined core outcomes to guide clinical decision-making.

Indexed as

Femur Head NecrosisFemur HeadHumansMagnetic Resonance ImagingPractice Guidelines as Topicavascular necrosisbone graftcore decompressionosteonecrosisosteotomystem cells

Identifiers

PMID41892822
PMCPMC13027876

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

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.