Toward Standardized Reporting in Non-Traumatic Osteonecrosis of the Femoral Head: Recommendations for Clinical Study Design and Reporting.

Clinical studies of osteonecrosis of the femoral head (ONFH) demonstrate substantial heterogeneity in terminology, diagnostic criteria, staging systems, lesion characterization, treatment description, and outcome reporting. These inconsistencies limit comparability across studies, complicate the synthesis of evidence, and contribute to conflicting conclusions regarding the progression of disease and effectiveness of treatment. We propose a pragmatic, disease-specific reporting framework for clinical studies of ONFH aimed at improving transparency, reproducibility, and cross-study comparability. Key methodological domains were identified through critical appraisal of the existing literature and iterative expert input. Minimum and optimal reporting standards were defined to balance methodological rigor with feasibility across retrospective and prospective study designs. The proposed framework addresses key gaps in methodological reporting across clinical studies of ONFH. Adoption of this ONFH-specific reporting framework can improve interpretability of individual studies, facilitate meaningful comparison across investigations, and strengthen the quality of systematic reviews and meta-analyses. While further refinement and formal consensus are needed, consistent application of the proposed reporting standards represents an achievable step toward improving the methodological quality and clinical relevance of ONFH research.