{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:05:15Z","timestamp":1784030715821,"version":"3.55.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"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":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Osteonecrosis of the femoral head (ONFH) often leads to the collapse of the femoral head, ultimately resulting in patients undergoing premature total hip arthroplasty (THA). The surgical hip dislocation (SHD) technique is a type of hip-preserving surgery aimed at delaying or avoiding THA. This study aims to evaluate the clinical efficacy of SHD techniques through femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic ONFH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective analysis was conducted on the clinical data of 39 patients (39 hips) with non-traumatic ONFH who underwent SHD for treatment from 2016 to 2017. The Harris hip score (HHS) and the minimum clinically important difference (MCID) are used to evaluate clinical outcomes, while radiographic evaluations are conducted using X-rays. Kaplan-Meier survival analysis defined clinical failure as further THA, and conducted univariate survival analysis and Cox regression analysis. Any complications were recorded.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All patients were followed up for 24\u201372 months, with an average of (60\u2009\u00b1\u200913.0) months. At the last follow-up, based on the HHS, 25 patients (64.1%) reported excellent and good clinical outcomes. 29 patients (74.3%) achieved MCID. Imaging evaluation of the postoperative femoral head status showed that 6 cases improved, 20 cases remained stable, and 13 cases showed progressed. Out of 39 hips, 12 hips had postoperative clinical failure, resulting in a clinical success rate of 69.2%. Association Research Circulation Osseous (ARCO) stage, China-Japan Friendship Hospital (CJFH) classification, and postoperative crutch-bearing time are risk factors for clinical failure. Postoperative crutch-bearing time of less than 3 months is an independent risk factor for clinical failure. After surgery, there was one case of sciatic nerve injury and one case of heterotopic ossification. There were no infections or non-union of the greater trochanter osteotomy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The SHD technique through the femoral head fovea fenestration and impaction bone grafting provides a safe and effective method for treating non-traumatic ONFH, with good mid-term clinical outcomes. ARCO staging, CJFH classification, and postoperative crutch-bearing time are risk factors that affect clinical outcomes after surgery and lead to further THA. Insufficient postoperative crutch-bearing time is an independent risk factor for clinical failure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-024-04901-x","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T21:03:34Z","timestamp":1722027814000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Surgical hip dislocation technique through the femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic osteonecrosis of the femoral head: a retrospective study"],"prefix":"10.1186","volume":"19","author":[{"given":"Dawei","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoyan","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiantao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"issue":"11","key":"4901_CR1","first-page":"1319","volume":"36","author":"Association Related To Circulation Osseous Chinese Microcirculation Society C-A","year":"2022","unstructured":"Association Related To Circulation Osseous Chinese Microcirculation Society C-A. [Expert consensus on clinical diagnosis and treatment technique of osteonecrosis of the femoral head (2022 version)]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022;36(11):1319\u201326.","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"issue":"21","key":"4901_CR2","doi-asserted-by":"publisher","first-page":"2843","DOI":"10.4103\/0366-6999.168017","volume":"128","author":"DW Zhao","year":"2015","unstructured":"Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its Associated Risk factors in the Chinese Population: results from a nationally Representative Survey. Chin med j-peking. 2015;128(21):2843\u201350.","journal-title":"Chin med j-peking"},{"key":"4901_CR3","doi-asserted-by":"crossref","unstructured":"Banerjee S, Kapadia BH, Jauregui JJ, Cherian JJ, Mont MA. Natural History of Osteonecrosis. 2014.","DOI":"10.1007\/978-3-642-35767-1_20"},{"issue":"12","key":"4901_CR4","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.2106\/JBJS.I.00575","volume":"92","author":"MA Mont","year":"2010","unstructured":"Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J bone Joint surg am. 2010;92(12):2165\u201370.","journal-title":"J bone Joint surg am"},{"issue":"11","key":"4901_CR5","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1302\/0301-620X.98B11.38042","volume":"98\u2013b","author":"GS Matharu","year":"2016","unstructured":"Matharu GS, Berryman F, Brash L, Pynsent PB, Dunlop DJ, Treacy RB. Can blood metal ion levels be used to identify patients with bilateral Birmingham hip resurfacings who are at risk of adverse reactions to metal debris? Bone Joint j. 2016;98\u2013b(11):1455\u201362.","journal-title":"Bone Joint j"},{"issue":"10","key":"4901_CR6","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1302\/0301-620X.99B10.BJJ-2017-0233.R2","volume":"99\u2013b","author":"M Chughtai","year":"2017","unstructured":"Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint j. 2017;99\u2013b(10):1267\u201379.","journal-title":"Bone Joint j"},{"issue":"3","key":"4901_CR7","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1080\/14712598.2021.1862790","volume":"21","author":"F Migliorini","year":"2021","unstructured":"Migliorini F, Maffulli N, Eschweiler J, Tingart M, Baroncini A. Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis. Expert Opin biol th. 2021;21(3):423\u201330.","journal-title":"Expert Opin biol th"},{"issue":"1","key":"4901_CR8","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1093\/bmb\/ldaa044","volume":"137","author":"M Quaranta","year":"2021","unstructured":"Quaranta M, Miranda L, Oliva F, Aletto C, Maffulli N. Osteotomies for avascular necrosis of the femoral head. Brit med bull. 2021;137(1):98\u2013111.","journal-title":"Brit med bull"},{"issue":"1","key":"4901_CR9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/bmb\/ldw010","volume":"118","author":"F Sadile","year":"2016","unstructured":"Sadile F, Bernasconi A, Russo S, Maffulli N. Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis. Brit med bull. 2016;118(1):33\u201349.","journal-title":"Brit med bull"},{"issue":"8","key":"4901_CR10","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1302\/0301-620X.83B8.0831119","volume":"83","author":"R Ganz","year":"2001","unstructured":"Ganz R, Gill TJ, Gautier E, Ganz K, Kr\u00fcgel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J bone Joint surg br. 2001;83(8):1119\u201324.","journal-title":"J bone Joint surg br"},{"issue":"2","key":"4901_CR11","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.ocl.2018.10.001","volume":"50","author":"A Cohen-Rosenblum","year":"2019","unstructured":"Cohen-Rosenblum A, Cui Q. Osteonecrosis of the femoral head. Orthop clin n am. 2019;50(2):139\u201349.","journal-title":"Orthop clin n am"},{"issue":"1","key":"4901_CR12","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s11999-013-3268-0","volume":"472","author":"SD Steppacher","year":"2014","unstructured":"Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenrock KA. Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat r. 2014;472(1):337\u201348.","journal-title":"Clin Orthop Relat r"},{"issue":"45","key":"4901_CR13","doi-asserted-by":"publisher","first-page":"e5272","DOI":"10.1097\/MD.0000000000005272","volume":"95","author":"WC Li","year":"2016","unstructured":"Li WC, Xu RJ. Lateral shelf acetabuloplasty for severe Legg-Calv\u00e9-Perthes disease in patients older than 8 years: a mean eleven-year follow-up. Medicine. 2016;95(45):e5272.","journal-title":"Medicine"},{"issue":"12","key":"4901_CR14","doi-asserted-by":"publisher","first-page":"3744","DOI":"10.1007\/s11999-015-4352-4","volume":"473","author":"A Mass\u00e8","year":"2015","unstructured":"Mass\u00e8 A, Aprato A, Alluto C, Favuto M, Ganz R. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat r. 2015;473(12):3744\u201351.","journal-title":"Clin Orthop Relat r"},{"issue":"12","key":"4901_CR15","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1302\/0301-620X.98B12.BJJ-2016-0251.R1","volume":"98\u2013b","author":"DC Dewar","year":"2016","unstructured":"Dewar DC, Lazaro LE, Klinger CE, et al. The relative contribution of the medial and lateral femoral circumflex arteries to the vascularity of the head and neck of the femur: a quantitative MRI-based assessment. Bone Joint j. 2016;98\u2013b(12):1582\u20138.","journal-title":"Bone Joint j"},{"issue":"5","key":"4901_CR16","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1302\/0301-620X.82B5.0820679","volume":"82\u2013b","author":"E Gautier","year":"2000","unstructured":"Gautier E, Ganz K, Kr\u00fcgel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J bone Joint surg br. 2000;82\u2013b(5):679\u201383.","journal-title":"J bone Joint surg br"},{"issue":"2","key":"4901_CR17","doi-asserted-by":"publisher","first-page":"409","DOI":"10.2106\/JBJS.G.01679","volume":"91","author":"M Kalhor","year":"2009","unstructured":"Kalhor M, Beck M, Huff TW, Ganz R. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J bone Joint surg am. 2009;91(2):409\u201318.","journal-title":"J bone Joint surg am"},{"issue":"02","key":"4901_CR18","first-page":"153","volume":"36","author":"D Sheng","year":"2021","unstructured":"Sheng D, Song Q, Zhang Q, He W, Chen DTL. [Treatment of osteonecrosis of the femoral head at ARCO stage II and III of the young and middle-aged with autogenous iliac bone flap compression and bone grafting via surgical dislocation of the hip]. Chin J Bone Joint Injury. 2021;36(02):153\u20135.","journal-title":"Chin J Bone Joint Injury"},{"issue":"30","key":"4901_CR19","doi-asserted-by":"publisher","first-page":"50084","DOI":"10.18632\/oncotarget.15095","volume":"8","author":"C Yao","year":"2017","unstructured":"Yao C, Yi N, Shen J, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade IIIA-IIIB aseptic necrosis of femoral head (ANFH) patients. Oncotarget. 2017;8(30):50084\u201390.","journal-title":"Oncotarget"},{"issue":"4","key":"4901_CR20","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1177\/1120700019856010","volume":"30","author":"SD Steppacher","year":"2020","unstructured":"Steppacher SD, Sedlmayer R, Tannast M, Schmaranzer F, Siebenrock KA. Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis. Hip int. 2020;30(4):398\u2013406.","journal-title":"Hip int"},{"issue":"5","key":"4901_CR21","first-page":"531","volume":"33","author":"H Sun","year":"2019","unstructured":"Sun H, Wei B. [Impacting bone graft via surgical hip dislocation approach versus core decompression and bone graft for avascular necrosis of femoral head at ARCO stage III]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019;33(5):531\u20136.","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"issue":"3","key":"4901_CR22","first-page":"285","volume":"25","author":"LH Tang Yanfeng","year":"2020","unstructured":"Tang Yanfeng LH, Yang Yuxia L, Wuyin X, Jianing Y, Chen W, Huichao L. Treatment of femoral head necrosis with surgical dislocation through fovea bone grafting combined with autologous bone marrow concentrate and platelet-rich plasma gel. Chin J Anat Clin. 2020;25(3):285\u201391.","journal-title":"Chin J Anat Clin"},{"issue":"11","key":"4901_CR23","first-page":"46","volume":"25","author":"Z Zhuang","year":"2017","unstructured":"Zhuang Z, Wu Z, Xie Q, Gong Z, Lin X, Zhang H, et al. [Treatment of 22 cases of osteonecrosis of femoral head in Middle-aged and young adults with ARCO Stage III by Traditional Chinese Medicine Combined with Surgical hip dislocation and bone grafting]. Chin J Trad Med Traum Orthop. 2017;25(11):46\u20134851.","journal-title":"Chin J Trad Med Traum Orthop"},{"issue":"5","key":"4901_CR24","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/j.1600-0501.2010.02039.x","volume":"22","author":"A Kruse","year":"2011","unstructured":"Kruse A, Jung RE, Nicholls F, Zwahlen RA, H\u00e4mmerle CH, Weber FE. Bone regeneration in the presence of a synthetic hydroxyapatite\/silica oxide-based and a xenogenic hydroxyapatite-based bone substitute material. Clin oral Implan res. 2011;22(5):506\u201311.","journal-title":"Clin oral Implan res"},{"issue":"11","key":"4901_CR25","doi-asserted-by":"publisher","first-page":"2833","DOI":"10.1002\/jbm.a.35828","volume":"104","author":"S Chiba","year":"2016","unstructured":"Chiba S, Anada T, Suzuki K, et al. Effect of resorption rate and osteoconductivity of biodegradable calcium phosphate materials on the acquisition of natural bone strength in the repaired bone. J Biomed Mater res a. 2016;104(11):2833\u201342.","journal-title":"J Biomed Mater res a"},{"issue":"11","key":"4901_CR26","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1016\/j.jbiomech.2005.06.026","volume":"39","author":"H Yoshida","year":"2006","unstructured":"Yoshida H, Faust A, Wilckens J, Kitagawa M, Fetto J, Chao EY. Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living. J Biomech. 2006;39(11):1996\u20132004.","journal-title":"J Biomech"},{"issue":"7","key":"4901_CR27","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/S0021-9290(01)00041-0","volume":"34","author":"E Genda","year":"2001","unstructured":"Genda E, Iwasaki N, Li G, MacWilliams BA, Barrance PJ, Chao EY. Normal hip joint contact pressure distribution in single-leg standing\u2013effect of gender and anatomic parameters. J Biomech. 2001;34(7):895\u2013905.","journal-title":"J Biomech"},{"issue":"2","key":"4901_CR28","first-page":"85","volume":"21","author":"F Migliorini","year":"2023","unstructured":"Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Prognostic factors in the management of osteonecrosis of the femoral head: a systematic review. Surg-j r coll surg e. 2023;21(2):85\u201398.","journal-title":"Surg-j r coll surg e"},{"issue":"12","key":"4901_CR29","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.2106\/JBJS.J.00794","volume":"93","author":"EL Sink","year":"2011","unstructured":"Sink EL, Beaul\u00e9 PE, Sucato D, et al. Multicenter study of complications following surgical dislocation of the hip. J bone Joint surg am. 2011;93(12):1132\u20136.","journal-title":"J bone Joint surg am"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04901-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-024-04901-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04901-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T21:29:47Z","timestamp":1722029387000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-024-04901-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,26]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4901"],"URL":"https:\/\/doi.org\/10.1186\/s13018-024-04901-x","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,26]]},"assertion":[{"value":"5 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Due to the retrospective nature of this study, the local ethics committee of our institution declined to provide ethical approval for the research. Prior to the procedure, informed consent was obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication was obtained from all participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"437"}}