{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:02:52Z","timestamp":1789646572000,"version":"4.0.0"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC3601900"],"award-info":[{"award-number":["2022YFC3601900"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82572860"],"award-info":[{"award-number":["82572860"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to systematically review and compare the clinical and radiographic outcomes of different bone defect filler materials following lesion debridement for osteonecrosis of the femoral head (ONFH). Existing evidence on filler materials relies heavily on isolated pairwise comparisons, leaving the optimal reconstruction strategy undefined. Therefore, the current network meta\u2010analysis integrates multiple treatments and diverse clinical endpoints to determine the most effective reconstructive option. With increasing recognition of the importance of intraosseous structural reconstruction, this study sought to provide evidence\u2010based guidance for filler selection in hip\u2010preserving treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, MEDLINE, Embase, the Cochrane Library, Web of Science, and Scopus were searched from inception to March 2026. Comparative clinical studies evaluating two or more bone defect filler materials after lesion debridement for ONFH were included. Evidence was synthesized using a Bayesian random\u2010effects network meta\u2010analysis. Methodological quality and risk of bias were assessed using the Cochrane Risk of Bias Tool 2.0 for randomized controlled trials (RCTs) and a modified Newcastle\u2013Ottawa Scale for non\u2010randomized comparative trials (NCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After screening 2046 records, 18 eligible studies were included, comprising 10 RCTs and 8 NCTs, with a total of 1176 patients and 1284 hips. Fourteen filler strategies were analyzed, including without graft, allograft, tantalum rods, iliac autograft, artificial bone, fibular autograft, vascularized iliac autograft, vascularized fibular autograft, artificial bone combined with iliac autograft, tantalum rods combined with autograft or allograft, other autografts, other autografts combined with vascularized greater trochanter graft, iliac autograft with screw fixation, and vascularized iliac autograft with screw fixation. Tantalum rods combined with bone graft showed relative advantages in functional recovery and pain relief, as assessed by the Harris Hip Score and Visual Analogue Scale. However, tantalum rods alone were associated with a higher rate of conversion to total hip arthroplasty. Allograft ranked favorably for early functional recovery and necrosis stage maintenance, although no significant differences were observed among interventions for necrosis stage maintenance. Iliac autograft with screw fixation ranked first in preventing radiographic progression. However, without significant pairwise differences, this ranking remains inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Considering postoperative functional recovery, pain relief, and disease progression after lesion debridement, tantalum rods combined with bone graft may provide advantages in early outcomes, but the long\u2010term failure risk of tantalum rods alone should be carefully considered. Allograft and iliac autograft with screw fixation showed favorable profiles in specific outcome domains and may represent balanced options in selected patients. Further high\u2010quality studies with longer follow\u2010up are needed to validate the long\u2010term efficacy of different filler strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70428","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:21:34Z","timestamp":1789644094000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Efficacy of Bone Defect Filler Strategies Following Lesion Debridement for Osteonecrosis of the Femoral Head: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6915-9437","authenticated-orcid":false,"given":"Zukang","family":"Miao","sequence":"first","affiliation":[{"name":"College of Integrative Medicine of Tianjin University of Traditional Chinese Medicine  Tianjin China"},{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Pei","sequence":"additional","affiliation":[{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery Qilu Hospital of Shandong University (Qingdao)  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemeng","family":"Hou","sequence":"additional","affiliation":[{"name":"College of Integrative Medicine of Tianjin University of Traditional Chinese Medicine  Tianjin China"},{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingkun","family":"Jia","sequence":"additional","affiliation":[{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfei","family":"Zhao","sequence":"additional","affiliation":[{"name":"College of Integrative Medicine of Tianjin University of Traditional Chinese Medicine  Tianjin China"},{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Dai","sequence":"additional","affiliation":[{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolei","family":"Sun","sequence":"additional","affiliation":[{"name":"Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlong","family":"Ma","sequence":"additional","affiliation":[{"name":"Tianjin Hospital, Tianjin University  Tianjin China"},{"name":"Orthopedic Research Institute, Tianjin Hospital, Tianjin University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"12","key":"e_1_2_14_2_1","first-page":"1084","article-title":"Nontraumatic Osteonecrosis of the Femoral Head: Where Do we Stand Today?: A 5\u2010Year Update","volume":"102","author":"Mont M. 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