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

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.