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Background <p> The long-term durability of total hip arthroplasty remains challenging in young patients with osteonecrosis of the femoral head (ONFH), necessitating effective hip-preserving strategies. However, existing techniques are diverse but lack a unifying principle for precise treatment selection. Reconstruction of the anterolateral pillar of the femoral head may be a promising guideline.</p> Main body <p> The anterolateral pillar encompasses approximately one-third of the anterior and lateral femoral head, whereas the functional pillar denotes this region corresponding to the lateral third of acetabular weight-bearing portion. Its structural integrity is critical for risk stratification and prognosis. Centering on this concept of the biomechanical significance of anterolateral pillar of the femoral head, this review discusses the current classification systems and reclassifies hip-preserving techniques. Among intra-femoral head strategies involving in anterolateral pillar reconstruction, pharmacological agent and core decompression with bio-augmentation provide no direct structural support and largely depend on the residual bone stock in the femoral head. Implant-based approaches, including bone and biomaterial grafting, hinge not only on implant properties but also on whether these can achieve targeted mechanical support to the anterolateral pillar. Extra-femoral head reconstruction procedures, particularly proximal femoral or acetabular osteotomy, restore function by transferring viable bone into weight-bearing areas or optimizing acetabular coverage through anatomical reconfiguration, thereby indirectly reconstructing the pillar’s load-bearing role.</p> Conclusions <p> Establishing direct or indirect reconstruction of the anterolateral pillar as a unifying principle can standardize precision-based treatment for ONFH. Optimal clinical outcomes are further enhanced when orthopedic surgeons select reconstruction strategies tailored to their surgical expertise.</p>

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Anterolateral pillar reconstruction for enhanced hip preservation in osteonecrosis of the femoral head

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月14日

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  • Hanming Tang,
  • Wei He,
  • Hue H. Luu,
  • Youwen Liu,
  • Yuhao Liu

摘要

Background

The long-term durability of total hip arthroplasty remains challenging in young patients with osteonecrosis of the femoral head (ONFH), necessitating effective hip-preserving strategies. However, existing techniques are diverse but lack a unifying principle for precise treatment selection. Reconstruction of the anterolateral pillar of the femoral head may be a promising guideline.

Main body

The anterolateral pillar encompasses approximately one-third of the anterior and lateral femoral head, whereas the functional pillar denotes this region corresponding to the lateral third of acetabular weight-bearing portion. Its structural integrity is critical for risk stratification and prognosis. Centering on this concept of the biomechanical significance of anterolateral pillar of the femoral head, this review discusses the current classification systems and reclassifies hip-preserving techniques. Among intra-femoral head strategies involving in anterolateral pillar reconstruction, pharmacological agent and core decompression with bio-augmentation provide no direct structural support and largely depend on the residual bone stock in the femoral head. Implant-based approaches, including bone and biomaterial grafting, hinge not only on implant properties but also on whether these can achieve targeted mechanical support to the anterolateral pillar. Extra-femoral head reconstruction procedures, particularly proximal femoral or acetabular osteotomy, restore function by transferring viable bone into weight-bearing areas or optimizing acetabular coverage through anatomical reconfiguration, thereby indirectly reconstructing the pillar’s load-bearing role.

Conclusions

Establishing direct or indirect reconstruction of the anterolateral pillar as a unifying principle can standardize precision-based treatment for ONFH. Optimal clinical outcomes are further enhanced when orthopedic surgeons select reconstruction strategies tailored to their surgical expertise.