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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Osteonecrosis of the Femoral Head | Research article

A delphi-based model for prognosis of femoral head collapse in osteonecrosis: a multi-factorial approach

Authors: Tong-jie Yang, Shi-yi Sun, Lei Zhang, Xing-ping Zhang, Hai-jun He

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

Osteonecrosis of the femoral head (ONFH) is a progressive and debilitating condition characterized by the death of bone tissue due to inadequate blood supply. Despite advances in diagnostic imaging and treatment strategies, predicting the risk of femoral head collapse remains a significant clinical challenge. This study seeks to address this gap by developing a robust prognostic model that integrates clinical, imaging, and laboratory data to improve early diagnosis and guide therapeutic decision-making.

Methods

We conducted a qualitative systematic review and employed the Delphi method to select key prognostic factors from clinical data, imaging findings, and laboratory indicators. The study included ONFH patients treated from January 2014 to December 2021. We used univariate and multivariate Cox regression analyses to develop a nomogram for predicting the risk of femoral head collapse. The model’s performance was evaluated using the concordance index (C-index), calibration plots, and decision curve analysis (DCA).

Results

The study included 297 patients (454 hips) with ONFH. Key prognostic factors identified included pain presence (p < 0.001, RR = 0.185, 95% CI: 0.11–0.31), JIC classification (C1: p < 0.001, RR = 0.096, 95% CI: 0.054–0.171; C2: p < 0.001, RR = 0.323, 95% CI: 0.215–0.487), necrotic area (3 < MNAI < 6: p < 0.001, RR = 0.107, 95% CI: 0.061–0.190; MNAI ≥ 6: p < 0.001, RR = 0.466, 95% CI: 0.314–0.692), weight-bearing reduction (p < 0.001, RR = 0.466, 95% CI: 0.323–0.672), preservation of the anterolateral pillar (p < 0.001, RR = 0.223, 95% CI: 0.223–0.473), and subchondral bone fracture on CT (p < 0.001, RR = 0.32, 95% CI: 0.217–0.472). The nomogram demonstrated a high C-index of 0.88, indicating excellent predictive accuracy. Calibration plots showed good agreement between predicted and observed outcomes, and DCA confirmed the model’s clinical utility.

Conclusions

The prognostic model developed in this study provides a reliable tool for predicting femoral head collapse in ONFH patients. It allows for early identification of high-risk patients, guiding personalized treatment strategies to improve patient outcomes and reduce the need for invasive surgical procedures.

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Title: A delphi-based model for prognosis of femoral head collapse in osteonecrosis: a multi-factorial approach
Authors: Tong-jie Yang
Shi-yi Sun
Lei Zhang
Xing-ping Zhang
Hai-jun He
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Osteonecrosis of the Femoral Head
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-05247-0

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A delphi-based model for prognosis of femoral head collapse in osteonecrosis: a multi-factorial approach

Abstract

Background

Methods

Results

Conclusions

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Please log in to get access to this content

Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method

Correlation between vascular endothelial growth factor A gene polymorphisms and tendon and ligament injury risk: a systematic review and meta-analysis

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