{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T01:03:56Z","timestamp":1772672636950,"version":"3.50.1"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T00:00:00Z","timestamp":1623456000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T00:00:00Z","timestamp":1623456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8\u201383.4%) and the natural course group (72.2, 95% confidence interval 64.8\u201379.6%) at 5\u2009years (log-rank, <jats:italic>P<\/jats:italic>\u2009=\u2009.191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>The trial was registered in the Chinese Clinical Trial Registry (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/showproj.aspx?proj=57404\">ChiCTR2000035180<\/jats:ext-link>) dated 2 August 2020.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-021-04418-y","type":"journal-article","created":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T19:02:48Z","timestamp":1623524568000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course"],"prefix":"10.1186","volume":"22","author":[{"given":"Zunhan","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuetao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Nan","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enze","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongke","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,12]]},"reference":[{"issue":"17","key":"4418_CR1","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.2106\/JBJS.18.01218","volume":"101","author":"A Hart","year":"2019","unstructured":"Hart A, Janz V, Trousdale RT, et al. Long-term survivorship of Total hip Arthroplasty with highly cross-linked polyethylene for osteonecrosis. J Bone Joint Surg Am. 2019;101(17):1563\u20138.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"4418_CR2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3109\/17453674.2013.874927","volume":"85","author":"C Bergh","year":"2014","unstructured":"Bergh C, Fenstad AM, Furnes O, et al. Increased risk of revision in patients with non-traumatic femoral head necrosis. Acta Orthop. 2014;85(1):11\u20137.","journal-title":"Acta Orthop"},{"issue":"11","key":"4418_CR3","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1007\/s00402-020-03364-z","volume":"140","author":"J-K Moon","year":"2020","unstructured":"Moon J-K, Yoon JY, Kim C-H, et al. Multiple drilling and multiple matchstick-like bone allografts for large osteonecrotic lesions in the femoral head: an average 3-year follow-up study. Arch Orthop Trauma Surg. 2020;140(11):1655\u201363.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"4418_CR4","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.2106\/JBJS.19.01271","volume":"102","author":"MA Mont","year":"2020","unstructured":"Mont MA, Salem HS, Piuzzi NS, et al. Nontraumatic osteonecrosis of the femoral head: where do we stand today?: a 5-year update. J Bone Joint Surg Am. 2020;102(12):1084\u201399.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"4418_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12891-016-1199-0","volume":"17","author":"H Yin","year":"2016","unstructured":"Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord. 2016;17(1):1\u20138.","journal-title":"BMC Musculoskelet Disord"},{"key":"4418_CR6","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/01.blo.0000229342.96103.73","volume":"454","author":"WS Song","year":"2007","unstructured":"Song WS, Yoo JJ, Kim YM, Kim HJ. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res. 2007;454:139\u201346.","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"4418_CR7","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jbspin.2011.02.020","volume":"79","author":"P Kang","year":"2012","unstructured":"Kang P, Pei F, Shen B, et al. Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Joint Bone Spine. 2012;79(1):67\u201372.","journal-title":"Joint Bone Spine"},{"issue":"5","key":"4418_CR8","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1007\/s00402-013-1714-9","volume":"133","author":"OA Al","year":"2013","unstructured":"Al OA. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. Arch Orthop Trauma Surg. 2013;133(5):609\u201313.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"4418_CR9","doi-asserted-by":"publisher","first-page":"2528","DOI":"10.1007\/s10439-013-0851-1","volume":"41","author":"JY Bae","year":"2013","unstructured":"Bae JY, Kwak DS, Park KS, et al. Finite element analysis of the multiple drilling technique for early osteonecrosis of the femoral head. Ann Biomed Eng. 2013;41(12):2528\u201337.","journal-title":"Ann Biomed Eng"},{"issue":"1","key":"4418_CR10","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s12306-016-0431-2","volume":"101","author":"SP Mohanty","year":"2017","unstructured":"Mohanty SP, Singh KA, Kundangar R, et al. Management of non-traumatic avascular necrosis of the femoral head-a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskelet Surg. 2017;101(1):59\u201366.","journal-title":"Musculoskelet Surg"},{"issue":"4","key":"4418_CR11","first-page":"5207","volume":"8","author":"YC Hong","year":"2015","unstructured":"Hong YC, Zhong HM, Lin T, et al. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis. Int J Clin Exp Med. 2015;8(4):5207\u201316.","journal-title":"Int J Clin Exp Med"},{"issue":"2","key":"4418_CR12","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00402-015-2375-7","volume":"136","author":"A Roth","year":"2016","unstructured":"Roth A, Beckmann J, Bohndorf K, et al. S3-guideline non-traumatic adult femoral head necrosis. Arch Orthop Trauma Surg. 2016;136(2):165\u201374.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"5","key":"4418_CR13","doi-asserted-by":"publisher","first-page":"674","DOI":"10.2106\/00004623-199505000-00003","volume":"77","author":"SW Smith","year":"1995","unstructured":"Smith SW, Fehring TK, Griffin WL, et al. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am. 1995;77(5):674\u201380.","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"4418_CR14","doi-asserted-by":"publisher","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","volume":"51","author":"WH Harris","year":"1969","unstructured":"Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737\u201355.","journal-title":"J Bone Joint Surg Am"},{"key":"4418_CR15","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1097\/01.blo.0000150128.57777.8e","volume":"429","author":"MA Mont","year":"2004","unstructured":"Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res. 2004;429:131\u20138.","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"4418_CR16","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/s12891-018-2209-1","volume":"19","author":"TM Kraus","year":"2018","unstructured":"Kraus TM, Abele C, Freude T, et al. Duration of incapacity of work after tibial plateau fracture is affected by work intensity. BMC Musculoskelet Disord. 2018;19(1):281.","journal-title":"BMC Musculoskelet Disord"},{"issue":"5","key":"4418_CR17","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s007760200108","volume":"7","author":"N Sugano","year":"2002","unstructured":"Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7(5):601\u20135.","journal-title":"J Orthop Sci"},{"issue":"1","key":"4418_CR18","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1302\/0301-620X.77B1.7822393","volume":"77","author":"ME Steinberg","year":"1995","unstructured":"Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34\u201341.","journal-title":"J Bone Joint Surg Br."},{"issue":"Suppl 3","key":"4418_CR19","first-page":"27","volume":"88","author":"DR Steinberg","year":"2006","unstructured":"Steinberg DR, Steinberg ME, Garino JP, et al. Determining lesion size in osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88(Suppl 3):27\u201334.","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"4418_CR20","doi-asserted-by":"publisher","first-page":"200","DOI":"10.2106\/00004623-199902000-00007","volume":"81","author":"KJ Bozic","year":"1999","unstructured":"Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 1999;81(2):200\u20139.","journal-title":"J Bone Joint Surg Am"},{"key":"4418_CR21","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1097\/00003086-199603000-00020","volume":"324","author":"MA Mont","year":"1996","unstructured":"Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996;324:169\u201378.","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"4418_CR22","doi-asserted-by":"publisher","first-page":"2737","DOI":"10.1007\/s00264-018-3977-9","volume":"42","author":"BH Yoon","year":"2018","unstructured":"Yoon BH, Lee YK, Kim KC, et al. No differences in the efficacy among various core decompression modalities and non-operative treatment: a network meta-analysis. Int Orthop. 2018;42(12):2737\u201343.","journal-title":"Int Orthop"},{"key":"4418_CR23","first-page":"2790163","volume":"2018","author":"J Wang","year":"2018","unstructured":"Wang J, Wang J, Zhang K, et al. Bayesian network meta-analysis of the effectiveness of various interventions for nontraumatic osteonecrosis of the femoral head. Biomed Res Int. 2018;2018:2790163.","journal-title":"Biomed Res Int"},{"issue":"3","key":"4418_CR24","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1007\/s00264-020-04790-9","volume":"45","author":"O Andronic","year":"2020","unstructured":"Andronic O, Weiss O, Shoman H, et al. What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head? Int Orthop. 2020;45(3):605\u201313.","journal-title":"Int Orthop"},{"issue":"19","key":"4418_CR25","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","volume":"97","author":"MA Mont","year":"2015","unstructured":"Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: where do we stand today? J Bone Joint Surg Am. 2015;97(19):1604\u201327.","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"4418_CR26","doi-asserted-by":"publisher","first-page":"672","DOI":"10.5301\/HIP.2011.8760","volume":"21","author":"JE Hsu","year":"2011","unstructured":"Hsu JE, Wihbey T, Shah RP, et al. Prophylactic decompression and bone grafting for small asymptomatic osteonecrotic lesions of the femoral head. Hip Int. 2011;21(6):672\u20137.","journal-title":"Hip Int"},{"issue":"8","key":"4418_CR27","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00590-012-1141-6","volume":"23","author":"HJ Zhang","year":"2013","unstructured":"Zhang HJ, Liu YW, Du ZQ, et al. Therapeutic effect of minimally invasive decompression combined with impaction bone grafting on osteonecrosis of the femoral head. Eur J Orthop Surg Traumatol. 2013;23(8):913\u20139.","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"8","key":"4418_CR28","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s00402-012-1526-3","volume":"132","author":"L Helbig","year":"2012","unstructured":"Helbig L, Simank HG, Kroeber M, et al. Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2012;132(8):1095\u2013103.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"4418_CR29","doi-asserted-by":"publisher","first-page":"206","DOI":"10.5301\/hip.2011.6525","volume":"21","author":"BF Wei","year":"2018","unstructured":"Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int. 2018;21(2):206\u201310.","journal-title":"Hip Int"},{"issue":"8","key":"4418_CR30","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/j.arth.2009.08.019","volume":"25","author":"S Yang","year":"2010","unstructured":"Yang S, Wu X, Xu W, et al. Structural augmentation with biomaterial-loaded allograft threaded cage for the treatment of femoral head osteonecrosis. J Arthroplast. 2010;25(8):1223\u201330.","journal-title":"J Arthroplast"},{"issue":"5","key":"4418_CR31","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s00264-009-0822-1","volume":"34","author":"BL Wang","year":"2010","unstructured":"Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window. Int Orthop. 2010;34(5):635\u20139.","journal-title":"Int Orthop"},{"issue":"3","key":"4418_CR32","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S0883-5403(06)80086-0","volume":"8","author":"LM Nelson","year":"1993","unstructured":"Nelson LM, Clark CR. Efficacy of phemister bone grafting in nontraumatic aseptic necrosis of the femoral head. J Arthroplast. 1993;8(3):253\u20138.","journal-title":"J Arthroplast"},{"issue":"2","key":"4418_CR33","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1302\/0301-620X.81B2.0810349","volume":"81","author":"P Hernigou","year":"1999","unstructured":"Hernigou P, Beaujean F, Lambotte JC. Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint Surg Br. 1999;81(2):349\u201355.","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"4418_CR34","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s11999-011-2050-4","volume":"470","author":"JR Lieberman","year":"2011","unstructured":"Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the Osteonecrotic femoral head? Clin Orthop Relat Res. 2011;470(2):525\u201334.","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"4418_CR35","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s00402-015-2287-6","volume":"135","author":"S Landgraeber","year":"2015","unstructured":"Landgraeber S, Tran TN, Cla\u00dfen T, et al. Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 2015;135(10):1357\u201362.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"11","key":"4418_CR36","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1002\/term.1481","volume":"7","author":"S Landgraeber","year":"2013","unstructured":"Landgraeber S, Theysohn JM, Classen T, et al. Advanced core decompression, a new treatment option of avascular necrosis of the femoral head. J Tissue Eng Regen Med. 2013;7(11):893\u2013900.","journal-title":"J Tissue Eng Regen Med"},{"issue":"9","key":"4418_CR37","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.1007\/s00330-014-3216-8","volume":"24","author":"R Meier","year":"2014","unstructured":"Meier R, Kraus TM, Schaeffeler C, et al. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol. 2014;24(9):2271\u20138.","journal-title":"Eur Radiol"},{"key":"4418_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejrad.2019.01.002","volume":"112","author":"H Hatanaka","year":"2019","unstructured":"Hatanaka H, Motomura G, Ikemura S, et al. Differences in magnetic resonance findings between symptomatic and asymptomatic pre-collapse osteonecrosis of the femoral head. Eur J Radiol. 2019;112:1\u20136.","journal-title":"Eur J Radiol"},{"issue":"3","key":"4418_CR39","doi-asserted-by":"publisher","first-page":"735","DOI":"10.2214\/ajr.174.3.1740735","volume":"174","author":"S Iida","year":"2000","unstructured":"Iida S, Harada Y, Shimizu K, et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol. 2000;174(3):735\u201343.","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"4418_CR40","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1302\/0301-620X.82B6.0820837","volume":"82","author":"YM Kim","year":"2000","unstructured":"Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2000;82(6):837\u201341.","journal-title":"J Bone Joint Surg Br"},{"issue":"6","key":"4418_CR41","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.2214\/AJR.05.0086","volume":"186","author":"H Ito","year":"2006","unstructured":"Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol. 2006;186(6):1761\u201370.","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"4418_CR42","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1002\/term.2794","volume":"13","author":"S Serong","year":"2019","unstructured":"Serong S, Haversath M, Jager M, et al. Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head. J Tissue Eng Regen Med. 2019;13(4):546\u201354.","journal-title":"J Tissue Eng Regen Med"},{"issue":"8","key":"4418_CR43","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00402-013-1771-0","volume":"133","author":"CR Fraitzl","year":"2013","unstructured":"Fraitzl CR, Kappe T, Brugger A, et al. Reduced head-neck offset in nontraumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2013;133(8):1055\u201360.","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04418-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-021-04418-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04418-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T22:03:58Z","timestamp":1675461838000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-021-04418-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,12]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["4418"],"URL":"https:\/\/doi.org\/10.1186\/s12891-021-04418-y","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,12]]},"assertion":[{"value":"3 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee and Institutional Review Board of West China Hospital, Sichuan University (2012\u2013268). Informed consent was obtained from each patient or (dead) patient\u2019s next of kin or legally authorization representative of the patient. All methods were performed according to relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All patients provided consent to participate in current study, per our institution\u2019s standard for research consent forms, this consent specified that the research information obtained may be used for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The corresponding author Dr. Zongke Zhou is a member of the editorial board of BMC Musculoskeletal Disorders, the rest of authors declare they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"535"}}