{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:07:55Z","timestamp":1789571275071,"version":"build-2803163510"},"reference-count":70,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9,16]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:list list-type=\"plain\">\n                        <jats:list-item>\n                          <jats:p>\u27a2 Nontraumatic osteonecrosis of the femoral head should be suspected in patients who are &lt;50 years of age who have persistent hip pain despite normal radiographs.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Bilateral involvement is common; magnetic resonance imaging (MRI) of the contralateral hip is recommended.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 MRI is the most sensitive modality for detecting early disease.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Femoral head sphericity is assessed on anteroposterior, lateral, and 30\u00ba view radiographs.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Small pre-collapse lesions have the best prognosis. Large lateral lesions and subchondral collapse predict rapid progression.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Systemic risk factors and multifocal disease should be actively evaluated.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Joint-preserving procedures are most effective before structural collapse.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 Total hip arthroplasty remains the most reliable treatment after femoral head collapse.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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