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Purpose <p>To compare lesion debridement with bone grafting (LDBG) versus core decompression (CD) in preventing femoral head collapse in early glucocorticoid-associated osteonecrosis (GA-ONFH).</p> Methods <p>This single-center, superiority randomized controlled trial (Level I) enrolled 86 patients (18–60&#xa0;years) with ARCO stage II GA-ONFH, randomized to CD or LDBG. Primary outcome: proportion maintaining ARCO stage II at 24&#xa0;months. Secondary outcomes: interval-specific progression to collapse (0–6, 6–12, 12–24&#xa0;months) and Harris Hip Scores (HHS) among non-collapsed hips. Safety outcomes included perioperative blood loss, hospital stay, and surgery-related adverse events.</p> Results <p>Of 86 patients, 81 completed follow-up. At 24&#xa0;months, ARCO stage II was maintained in 70% (28/40) of LDBG vs. 41% (17/41) of CD patients (P = 0.010; RR = 1.69; NNT = 4). CD had better HHS at six&#xa0;months (P &lt; 0.001), but no difference at 12/24&#xa0;months among non-collapsed hips. CD involved less blood loss (P &lt; 0.001) and shorter hospital stays (P = 0.002); serious adverse events were similar (P = 0.72). Prespecified subgroup analyses showed consistent LDBG benefit, especially in females, patients with BMI &lt; 23.9, high glucocorticoid dose, and non-manual occupations.</p> Conclusion <p>LDBG significantly reduces collapse risk versus CD in early GA-ONFH, with comparable mid-term function and safety, supporting its use as a preferred joint-preserving strategy, particularly for females, patients with lower BMI (&lt; 23.9), high glucocorticoid exposure, and non-manual occupations.</p>

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In stage II osteonecrosis, bone grafting delays femoral head collapse compared with core decompression in glucocorticoid-associated osteonecrosis of the femoral head

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Tanxiao Chen,
  • Meiyi Chen,
  • Yiyao Li,
  • Deng Li,
  • Zhiqing Cai,
  • Hao Sun,
  • Ruofan Ma,
  • Jie Xu

摘要

Purpose

To compare lesion debridement with bone grafting (LDBG) versus core decompression (CD) in preventing femoral head collapse in early glucocorticoid-associated osteonecrosis (GA-ONFH).

Methods

This single-center, superiority randomized controlled trial (Level I) enrolled 86 patients (18–60 years) with ARCO stage II GA-ONFH, randomized to CD or LDBG. Primary outcome: proportion maintaining ARCO stage II at 24 months. Secondary outcomes: interval-specific progression to collapse (0–6, 6–12, 12–24 months) and Harris Hip Scores (HHS) among non-collapsed hips. Safety outcomes included perioperative blood loss, hospital stay, and surgery-related adverse events.

Results

Of 86 patients, 81 completed follow-up. At 24 months, ARCO stage II was maintained in 70% (28/40) of LDBG vs. 41% (17/41) of CD patients (P = 0.010; RR = 1.69; NNT = 4). CD had better HHS at six months (P < 0.001), but no difference at 12/24 months among non-collapsed hips. CD involved less blood loss (P < 0.001) and shorter hospital stays (P = 0.002); serious adverse events were similar (P = 0.72). Prespecified subgroup analyses showed consistent LDBG benefit, especially in females, patients with BMI < 23.9, high glucocorticoid dose, and non-manual occupations.

Conclusion

LDBG significantly reduces collapse risk versus CD in early GA-ONFH, with comparable mid-term function and safety, supporting its use as a preferred joint-preserving strategy, particularly for females, patients with lower BMI (< 23.9), high glucocorticoid exposure, and non-manual occupations.