{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:36:51Z","timestamp":1783489011303,"version":"3.55.0"},"reference-count":88,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint-preserving procedures, particularly where alternative techniques such as core decompression or vascularised bone grafting are anticipated to fail. Proximal femoral osteotomy is a technique that aims to remove the necrotic segment from the weight bearing area. The presented review aims to examine the efficacy of this technique in the management of avascular necrosis of the femoral head, reporting both rates of conversion to total hip replacement and patient reported outcomes. Methods: This systematic review was conducted according to PRISMA guidelines. A search was conducted of PubMed, Ovid Medline, EMBASE, and the Cochrane Library using pre-defined search terms. Data were extracted, and descriptive data presented. Quality of each study was assessed using the NIH quality assessment tool for case series studies. Results: Fifty-three studies with data for 2686 osteotomies are presented. Progression of radiological arthrosis was present in 40% of cases, with 20.3% of patients having undergone conversion to THR at a mean of 75.4 months (range 20\u2013132 months). Patient-reported outcome measures were recorded in 1416 patients, of which the Harris Hip Score was the most commonly utilised. This score improved from a mean of 58.3 to 84.4 at a mean follow-up of 102 months. Conclusions: Osteotomy represented a valid head-preserving technique in the armamentarium against avascular necrosis of the femoral head, with conversion to THR required in 20.3% of patients at 7 years. In those patients who did not require THR, PROMS were similar to the arthroplasty population.<\/jats:p>","DOI":"10.3390\/jcm14155592","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T12:15:40Z","timestamp":1754568940000},"page":"5592","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Role of Proximal Femoral Osteotomy for the Treatment of Avascular Necrosis: A Systematic Review of Clinical and Patient-Reported Outcomes"],"prefix":"10.3390","volume":"14","author":[{"given":"Paul L.","family":"Rodham","sequence":"first","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospital NHS Trust, Leeds LS7 4SA, UK"},{"name":"Academic Department of Trauma and Orthopaedics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamila Tukur","family":"Jido","sequence":"additional","affiliation":[{"name":"Foundation School, Queen Elizabeth Hospital, Glasgow G4 0SF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Bethell","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios P.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospital NHS Trust, Leeds LS7 4SA, UK"},{"name":"Academic Department of Trauma and Orthopaedics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-1432","authenticated-orcid":false,"given":"Michalis","family":"Panteli","sequence":"additional","affiliation":[{"name":"Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1695-1519","authenticated-orcid":false,"given":"Nikolaos K.","family":"Kanakaris","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospital NHS Trust, Leeds LS7 4SA, UK"},{"name":"Academic Department of Trauma and Orthopaedics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-7696","authenticated-orcid":false,"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospital NHS Trust, Leeds LS7 4SA, UK"},{"name":"Academic Department of Trauma and Orthopaedics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9LU, UK"},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"ref_1","first-page":"e21.00176","article-title":"Osteonecrosis of the Femoral Head","volume":"6","author":"George","year":"2022","journal-title":"J. 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