Idiopathic Osteonecrosis Research Articles

Aseptic osteonecrosis of the femoral head (ONFH) is a debilitating orthopedic disorder that predominantly affects young adults and has a multifactorial etiology. In mining-intensive regions such as Katanga (Democratic Republic of the Congo), chronic exposure to trace metal elements (TMEs) has raised concerns about potential environmental contributors to bone disease. This study aimed to investigate the association between bone TME accumulation and the occurrence of idiopathic ONFH in an environmentally exposed population. A case-control study was conducted between 2017 and 2025 at Medpark Clinic, Lubumbashi. Femoral head specimens were collected from 56 patients undergoing total hip arthroplasty, including 36 cases of idiopathic ONFH and 20 controls with primary osteoarthritis. Bone concentrations of eleven TMEs (Pb, Co, Cd, Cr, Zn, Cu, As, Mn, Mg, Ni, Al) were quantified using inductively coupled plasma-optical emission spectrometry (ICP-OES). Exposure was defined as a Z-score > 2 compared with a local reference population. Bivariate and multivariate logistic regression analyses were performed to assess associations. Patients with ONFH were significantly younger than controls (mean age: 49.5 vs. 62.9 years; p = 0.004). Bone concentrations of lead and cobalt were markedly higher in ONFH cases. In multivariate analysis, elevated bone lead levels (adjusted OR = 23.75; 95% CI: 2.30-181.57) and age ≤ 50 years were independently associated with ONFH. No significant associations were found for other TMEs. This study provides the first direct evidence that chronic bone accumulation of lead and cobalt is strongly associated with idiopathic ONFH in a mining-exposed African population. These findings highlight the urgent need for environmental monitoring, targeted public health interventions, and early clinical surveillance in high-risk regions.

Legg-Calvé-Perthes disease has been recognized for more than 100 years. It is an idiopathic osteonecrosis of the femoral head in children that follows a predictable course of bone death, revascularization, bone resorption, and eventually reossification and bone healing. The natural history is often favorable for children younger than 6 years and poor for children older than 8 to 10 years. The final outcome is determined by the shape of the healed femoral head and its congruence with the acetabulum. Treatment is aimed at preserving range of motion, maintaining containment, and limiting mechanical damage to the femoral head. Nonsurgical interventions include restricted weight-bearing, range of motion exercises, and casting or bracing treatment. Surgical interventions include osteotomies of the femur or pelvis or both to maintain containment, as well as joint distraction for containment and decreasing mechanical force. Superiority of a particular treatment strategy has been difficult to demonstrate due to relative rarity of the condition, variable natural history, and long-time horizon to predict final outcome. Recent research has focused on better imaging predictors and understanding and altering the pathophysiology subsequent to the vascular disturbance.

BackgroundOsteonecrosis of the femoral head (ONFH) is a progressive, debilitating orthopedic condition that primarily results from compromised vascular supply. Chronic alcohol intake is a well-established non-traumatic etiological factor in ONFH. Despite the increasing global research on ONFH, a bibliometric analysis using explicit literature searches in Web of Science reveals that no studies have specifically focused on alcohol-induced osteonecrosis of the femoral head (AONFH). This study aims to provide a comprehensive overview of the global research landscape of AONFH, identifying key research hotspots, emerging trends, and future directions using both qualitative and quantitative bibliometric methods.MethodsThe Web of Science Core Collection was systematically searched for publications from 1998 to 2024 related to AONFH and identified 353 relevant articles. RStudio and Bibliometrix 4.1.0 were used to analyze annual publication volume and cited papers. VOSviewer was employed to conduct bibliographic coupling analysis and CiteSpace was used to analyze countries, institutions, authors, journals, and keywords. Microsoft Excel 2019 was utilized to perform linear regression on annual publication volume.ResultsClinical Orthopaedics and Related Research had the highest number of publications and citations. Chinese scholars published the most, while U.S.-based research received greater international recognition. Shanghai Jiao Tong University ranked first in institutional output. Sugano Nobuhiko and Fukushima Wakaba were identified as the most influential scholars. The main research hotspots—as measured by keyword centrality and frequency—were “risk factors” and “core decompression,” followed by “total hip arthroplasty,” “alcohol intake,” and “steroid-induced osteonecrosis.” Over time, the focus of AONFH research has shifted from broader themes such as “disease,” “smoking,” “occupational status,” and “idiopathic osteonecrosis” to more specialized areas including “gene expression,” “polymorphisms,” “steroid-induced osteonecrosis,” and “risk factors.”ConclusionAONFH research has progressed significantly, especially with its transition from basic science to precision medicine, including innovations such as genomics and stem cell therapy. Early diagnosis and intervention are critical to improving outcomes. Future research is expected to focus on refining the identification of risk factors, optimizing core decompression techniques, and incorporating precision medicine to enhance the quality of life and long-term prognosis of patients with AONFH.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-025-06138-8.

Classifications in Brief: Japanese Investigation Committee Classification for Idiopathic Osteonecrosis of the Femoral Head.

Idiopathic osteonecrosis of the jaw in dogs is a rare disease. Research into human osteonecrosis of the jaw has increased considerably in recent years revealing numerous underlying risk factors and comorbidities. The goal of this case series was to evaluate similar risk factors and comorbidities in dogs. The medical records from 10 cases were retrospectively reviewed for patient signalment, diagnostic results and treatment. Most cases had either cone beam or conventional computed tomography performed which allowed a detailed evaluation of maxillofacial structures. In this cohort, lesions had a predilection for the caudal maxilla and ipsilateral zygomatic arch and dental surgery did not always precede development of lesions. More cases and additional diagnostics will be needed to uncover the etiology of this disease.

This study aimed to investigate whether idiopathic osteonecrosis of the femoral head (ONFH) is associated with alterations in the microstructure, histological characteristics, and transcriptomic signature in the trabecular region of the femoral head. For this purpose, we obtained trabecular bone explants from the femoral head and the intertrochanteric region of patients with idiopathic ONFH and age- matched patients with primary osteoarthritis (OA). Trabecular bone from the femoral head of ONFH patients showed lower trabecular thickness, bone volume fraction and degree of anisotropy, and a higher percentage of empty lacunae than bone samples from the intertrochanteric region of the same patients and from the femoral head of the OA group. The transcriptome analysis identified a substantial number of genes exclusively regulated in the femoral head of ONFH patients. Among these genes, we found that those highly expressed around the necrotic lesion were involved in cell division and immune response. By contrast, downregulated genes were mainly involved in cell adhesion, angiogenesis and bone formation, such as those encoding collagen type I, bone sialoprotein and several bone morphogenetic proteins. These data add new insights into mechanisms involved in the pathophysiology of idiopathic ONFH.

Pathologies of the subchondral bone include both structural alterations such as osteonecrosis and bone marrow edema. Both entities are amenable to pharmacological therapy. Presentation of current recommendations for drug therapy of osteonecrosis and bone marrow edema of the knee joint based on the clinical data. The currently available literature is evaluated and discussed. Antiresorptives such as bisphosphonates and denosumab and the osteoanabolic agent teriparatide therapeutically address the locally diminished bone density potentially resulting in insufficiency fractures. In contrast, vitaminK antagonists, heparin and new/direct oral anticoagulants, as well as iloprost exert their effects at the vascular and hemostatic level. All drug treatment concepts are "off-label" use. They are particularly promising in the early stages of primary, idiopathic osteonecrosis and bone marrow edema. In osteonecrosis and bone marrow edema of the knee joint, complementary drug therapy may be beneficial. However, the available data is not yet sufficiently robust for general treatment recommendations.

Developmental disorders of the hip joint are common in pediatric and adolescent populations, and imaging plays a pivotal role in their diagnosis and follow-up. Timely diagnosis and appropriate management are crucial to prevent complications, which can lead to long-term morbidity and poor quality of life. This article outlines the relevant aspects of normal hip development and reviews the imaging considerations in the common developmental hip disorders – developmental dysplasia of the hip (DDH), Legg–Calve–Perthes disease (LCPD), and slipped capital femoral epiphysis (SCFE). DDH results from acetabular or femoral head dysplasia and affects neonates, infants, and toddlers. Ultrasonography is the workhorse of diagnosis in neonates and infants before epiphyseal ossification. Radiographs are used for diagnosis in toddlers and older children, while magnetic resonance imaging (MRI) plays a significant role in cases with diagnostic dilemma. LCPD affects young boys in the age group of 2–14 years and is characterized by idiopathic osteonecrosis of the femoral head. Radiographs and MRI play the major role in the diagnosis and staging of LCPD. Depending on the stage of disease, radiographs show epiphyseal flattening, fragmentation, metaphyseal hyperlucency, etc., on radiographs and there may be corresponding altered epiphyseal T1 signal intensity, with subchondral T2 hyperintensity and femoral head deformation on MRI. SCFE is a type I Salter Harris injury with epiphyseal slip, affecting adolescents (predominantly males). Radiographs and MRI are primarily used for diagnosis and reveal epiphyseal slip with physeal edema and joint effusion/synovitis. Timely identification and management of SCFE avoids complications such as avascular necrosis, femoroacetabular impingement, and secondary osteoarthritis.

Periacetabular osteotomy (PAO) treats developmental dysplasia of the hip (DDH) by reducing load on the hip and improving joint function. Untreated DDH affects lower extremity alignment and alters knee morphology, with valgus alignment more pronounced in hip osteoarthritis secondary to DDH. While PAO may influence knee mechanics, its association with subchondral bone density in the tibiofemoral joint remains unclear. (1) To what degree is PAO associated with changes in the distribution of subchondral bone density in the knees of patients with DDH? (2) Is PAO associated with altered subchondral bone density distribution in patients with DDH such that they more closely resemble a control cohort of patients? We conducted a retrospective chart review to evaluate the association of PAO with knees in female patients with DDH. From January 2015 to December 2021, 69 patients (≤ 49 years of age, center-edge angle ≤ 25°) underwent PAO. Of these, 38% (26) of patients were included after excluding patients for bilateral operations, lack of follow-up, or incomplete CT data. A power analysis required at least 20 hips per group based on the past study. For comparison, we reviewed 63 patients undergoing joint-preserving surgery for idiopathic osteonecrosis from January 2014 to December 2024, with 32% (20) of female patients meeting criteria (unilateral hip necrosis only) for the control group. PAO resulted in sufficient acetabular coverage and improved clinical scores in patients. Importantly, no change in lower limb alignment was observed postoperatively. The distribution and quantification of subchondral bone density in the proximal tibial articular surface were measured using CT osteoabsorptiometry (CT-OAM). This was achieved by assessing radiodensity variations in Hounsfield units (HUs) and mapping these as two-dimensional visualizations. The high-density area within these regions was defined as the top 20% of HUs. The medial and lateral tibial compartments were divided into three subregions of equal width in the coronal direction: lateral-lateral, lateral-central, lateral-medial, medial-medial, medial-central, and medial-lateral. Each subregion percentage represented by the high-density area was calculated (percentage of high-density area). Our primary study goal was to evaluate the association of PAO with changes in subchondral bone density distribution in the knees of patients with DDH. To achieve this, we utilized CT-OAM to map subchondral bone density patterns before and after surgery. Our secondary study goal was to determine whether PAO results in a subchondral bone density distribution in patients with DDH that more closely resembles that of a control cohort without DDH. For this goal, we analyzed radiographic and CT data to identify changes in high-density areas across tibial plateaus and compared preoperative and postoperative results within the PAO group and between the PAO and control groups. Preoperatively, the mean ± SD percentage of high-density area of the medial region was lower in the PAO group compared with the control group (control versus PAO preoperative 61% ± 12% versus 50% ± 20%; p = 0.02). After PAO, the percentage of high-density area of the medial region increased (preoperative versus postoperative 50% ± 20% versus 58% ± 19%; p = 0.003) and was not different from the control group postoperatively (control versus PAO postoperative 61% ± 12% versus 58% ± 19%; p = 0.16). Our findings suggest that DDH may cause a lateral shift in knee loading distribution. PAO appears to modify this loading pattern, based on subchondral bone density, making it more similar to one in a control cohort of knees. However, long-term follow-up studies are necessary to confirm whether early changes in subchondral bone density because of PAO are associated with subsequent knee degeneration. Level III, therapeutic study.

Legg-Calve-Perthes Disease (LCPD) is described as idiopathic avascular osteonecrosis of the capital femoral epiphysis in pediatrics. LCPD is usually present in children between 2 and 15 years and happens more frequently in boys more than girls; this study aims to compare the outcome of two surgical methods in treating LCPD. We included sixty patients with unilateral LCPD who underwent Salter or femoral varus osteotomy from 2007 to 2017. Patients were followed up for at least five years. Patients' claudication, pain, leg circumference, range of motion, lever arm ratio (LAR), neck shaft angle (NSA), migration index, vertical distance, and the presence of teardrop sign, sagging rope sign, and Trendelenburg sign were evaluated five years after surgery. The mean neck shaft angle, the lever arm ratio, migration index and, sagging rope sign incidence in patients undergoing femoral varus osteotomy were significantly lower than those undergoing Salter surgery; the thigh circumference was higher in patients undergoing femoral varus osteotomy than those undergoing Salter osteotomy. There were significant differences in biomechanical indices of hip and acetabulofemoral in salter and femoral varus osteotomy; the results of the current study are highly suggestive of prioritizing femoral varus osteotomy to Salter surgery.

AimsThe aim of this retrospective study was the evaluation of the patient-reported and radiological outcome of intravenous Iloprost therapy in the treatment of spontaneous osteonecrosis of the knee (SONK).Methods36 patients (age 57.3 ± 8.7 years, 38.9% women, 61.1% men) who received Iloprost between 2018 and 2021 due to SONK (ARCO I and II) were included in this retrospective cohort study. Outcome was evaluated by pre- and postinterventional pain (Numeric Rating Scale - NRS), patient reported outcome (subjective knee value (SKV), Oxford Knee Score (OKS)) at latest follow-up (2.9 months ± 1) as well as quantitative artificial intelligence assisted analysis of bone marrow edema (BME) in Magnetic Resonance Imaging (MRI) before and after 3 months.ResultsRadiologically, there was a 71% reduction in edema (pre-intervention: 37.0 cm³±37.7, post-intervention: 10.8 cm³ ± 14.9, p < 0.01). Overall satisfaction was 2.0 ± 1.3, SKV was 83.3%±16.6 and NRS at follow-up was 1.3 ± 1.8. OKS reached 33.6 ± 12.0. No major complications were observed. Rare side effects were dizziness which required premature termination of Ilomedin therapy on day 3.ConclusionIloprost treatment seems a safe and promising therapeutic option also in SONK with excellent subjective outcome and reduction of BME of 70% within 3 months after Iloprost infusion.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00402-025-06057-7.

Background: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done. Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases. Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed.

Aims: It was aimed to evaluate the alpha and Wiberg angles of patients with clinical and radiological diagnosis of idiopathic femoral head osteonecrosis (FHO) in comparison with the control group. Methods: Routine hip MRI (Magnetic resonance imaging) s between January 2022 and May 2024 were examined retrospectively. MRI images diagnosed with early stage (Stage I, II according to Ficat and Arlet classification), idiopathic femoral head osteonecrosis were recorded. A control group matched in age and gender was created. Alpha angle was measured as the angle between the parallel line drawn from the center of the femoral head to the femoral neck in axial MRIs and the line drawn from the transition point between the femoral head and neck in the anterior to the center of the femoral head. Wiberg's central corner angle was measured as the angle between the perpendicular line drawn from the center of the femoral head to the acetabulum and the line connecting the outermost point of the acetabulum in coronal images. Measurements were compared statistically in both groups. P&lt;0.05 was considered statistically significant. Results: A total of 70 hips were examined, including 35 FHO (13 unilateral and 11 bilateral hips) and 35 control groups (3 unilateral and 16 bilateral hips). There was no difference between the groups in terms of age and gender (P&gt;0.05). We found statistically significant differences in alpha and Wiberg angles between the FHO and control groups (P=0.04, P=0.025, respectively). There was no statistically significant difference between stages I and II in terms of alpha and Wiberg angles (P= 0.376, P= 0.078, respectively). Conclusion: These changes in hip angle measurements in this study may explain the cause of idiopathic FHO. We can predict femoral head osteonecrosis early.

Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease. We conducted a systematic review of all available abstracts associated with manuscripts in English or with English translation between January 2000 and December 2021, dealing with the treatment of Perthes' disease. Data collection included various study characteristics, surgical versus non-surgical management, treatment modality, mean follow-up time, analysis methods, and clinical recommendations. Our study included 130 manuscripts. Overall, 110 (85%) reported positive (beneficial) results, three (2%) reported negative results, and 17 (13%) reported no significant difference. Despite only 10/130 studies (8%) having a testable hypothesis, 71 (55%) recommended the use of their studied treatment methods for the patients, five (4%) made recommendations against the use of the studied treatment modality, and 54 (42%) did not make any recommendations. The overall rate for positive outcomes among included manuscripts regarding different treatment methods for Perthes' disease (85%) is higher than the 74% positive outcome rate found among studies for other surgically treated disorders and significantly higher than most scientific literature. Despite the lack of testable hypotheses, most manuscripts recommended their studied treatment method as a successful option for managing patients solely based on the reporting of retrospective data.

There is a clinical need for alternatives to gadolinium contrast-enhanced magnetic resonance imaging (MRI) to facilitate early detection and assessment of femoral head ischemia in pediatric patients with Legg-Calvé-Perthes disease (LCPD), a juvenile form of idiopathic osteonecrosis of the femoral head. The purpose of this study was to determine if intravoxel incoherent motion (IVIM), a noncontrast-enhanced MRI method to simultaneously measure tissue perfusion and diffusion, can detect femoral head ischemia using a piglet model of LCPD. Twelve 6-week-old piglets underwent unilateral hip surgery to induce complete femoral head ischemia. The unoperated, contralateral femoral head served as a perfused control. The bilateral hips of the piglets were imaged in vivo at 3T MRI using IVIM and contrast-enhanced MRI 1 week after surgery. Median apparent diffusion coefficient (ADC) and IVIM parameters (diffusion coefficient: Ds; perfusion coefficient: Df; perfusion fraction: f; and perfusion flux: f*Df) were compared between regions of interest comprising the epiphyseal bone marrow of the ischemic and control femoral heads. Contrast-enhanced MRI confirmed complete femoral head ischemia in 11/12 piglets. IVIM perfusion fraction (f) and flux (f*Df) were significantly decreased in the ischemic versus control femoral heads: on average, f decreased 47 ± 27% (Δf = -0.055 ± 0.034; p = 0.0003) and f*Df decreased 50 ± 27% (Δf*Df = -0.59 ± 0.49 × 10-3 mm2/s; p = 0.0026). In contrast, IVIM diffusion coefficient (Ds) and ADC were significantly increased in the ischemic versus control femoral heads: on average, Ds increased 78 ± 21% (ΔDs = 0.60 ± 0.14 × 10-3 mm2/s; p < 0.0001) and ADC increased 60 ± 36% (ΔADC = 0.50 ± 0.23 × 10-3 mm2/s; p < 0.0001). In conclusion, IVIM is sensitive in detecting bone marrow ischemia in a piglet model of LCPD.

ObjectivesMethylprednisolone (mPSL) pulse therapy is an essential option for patients with active systemic lupus erythematosus, but there is a risk of adverse events related to microcirculation disorders, including idiopathic osteonecrosis...

Legg-Calvé-Perthes disease is juvenile idiopathic osteonecrosis of the femoral head (ONFH) that has no effective clinical treatment. Previously, local injection of bone morphogenetic protein-2 (BMP2) for ONFH treatment showed a heterogeneous bone repair and a high incidence of heterotopic ossification (HO) due to the BMP2 leakage. Here, we developed a BMP2-hydrogel treatment via a transphyseal bone wash and subsequential injection of BMP2-loaded hydrogel. In vitro studies showed that a hydrogel of gelatin-heparin-tyramine retained the BMP2 for four weeks. The injection of the hydrogel can efficiently prevent leakage. With the bone wash, the injected hydrogel had a broad distribution in the head. In vivo studies on pigs revealed that the BMP2-hydrogel treatment produced a homogeneous bone regeneration without HO. It preserved the subchondral contour and restored the subchondral endochondral ossification, although it increased growth plate fusions. In summary, the study demonstrated a promising BMP2-hydrogel treatment for ONFH treatment, especially for teenagers.

BackgroundBone marrow edema syndrome (BMES), previously referred to as transient osteoporosis, is an uncommon and underdiagnosed self-limiting condition typically affecting the weight-bearing joints of the hip and lower limb. Its occurrence in upper limb or non-weight bearing joints is particularly rare.Case presentationWe report the case of an otherwise healthy 42-year-old man who gradually developed severe and disabling left shoulder pain over the course of 6 months. Nine months after onset, he presented clinically with bilateral involvement and radiologically (magnetic resonance imaging, MRI) with diffuse BME associated with a subchondral insufficiency fracture, suggestive of proximal humeral avascular necrosis. Clinical evidence of subacromial shoulder impingement and MRI findings of bilateral subchondral bursitis and tenosynovitis with effusion of the biceps tendons likely resulted from primary BME, as musculoskeletal sonography confirmed the absence of rotator cuff tears. Repeated MRI findings at 2, 12, and 18 months documented near complete resolution of both edema and fracture, consistent with BMES of the proximal humerus. During this time, the patient reported a gradual improvement in both pain symptoms and range of motion. The clinical picture of insidious shoulder pain, exacerbated by activity and improved by load relief, in the absence of predisposing factors for osteonecrosis or antecedent trauma in patients of middle age, should indicate the possibility of the diagnosis of BMES.ConclusionsThis unprecedented report documents a rare case of bilateral BMES of the humeral head mimicking avascular necrosis. The correct diagnosis of BMES within an atypical anatomical location avoids invasive measures in the affected bone. The misdiagnosis of secondary BME and idiopathic osteonecrosis can be avoided by recognizing the characteristics of BME and subchondral fractures of the humeral head in the absence of rotator cuff tears, as well as their evolution on serial MRI.

Background: Perthes disease is a form of juvenile idiopathic osteonecrosis characterized by temporary bone mortality due to inadequate blood supply to the femoral head. Objectives: This cross-sectional study aimed to evaluate the treatment outcomes and sequelae of Perthes Disease and to identify the most effective treatment modalities for managing its sequelae. Methods: The research enrolled 59 Perthes Disease patients who had completed treatment at our institution between 2021 and 2022. The information pertaining to demographic characteristics, clinical presentations, radiological findings, specific treatments administered, and follow-up records were collected. Pain levels and hip functionality were secondary outcome measures. The Harris Hip Score (HHS) was used to assess the primary outcome of quality of life. Practical Implication: The practical implications for treating the sequelae of Perthes disease include early detection, a multidisciplinary approach, conservative management, surgical interventions when necessary, rehabilitation and physical therapy, long-term monitoring, and patient and family education. Timely diagnosis, collaboration among healthcare professionals, tailored treatment plans, and regular follow-up are important for optimizing outcomes and managing the condition effectively. Results: The average age of the study population was 4.76+1.10 years, with a higher proportion of males. Left-sided (59.32%) participation was more prevalent than right-sided (37.28%) participation (p&lt;0.05). The disease's duration differed between patients. The majority of participants exhibited clinical symptoms such as hip or groin pain, limping, restricted hip movement, and deformities. The most prevalent treatment modality (p&lt;0.05) was physical therapy (52.54%), followed by orthotic devices (30.50%) and surgical interventions (16.94%). Surgical procedures employed both extra-articular (70%) and intra-articular techniques (10%) (p&lt;0.05). Conclusion: Multimodal, patient-specific approach is essential for managing Perthes disease sequelae. Physical therapy was the primary modality of care, while surgical interventions were employed selectively. Significant improvements were observed in pain reduction, functional outcomes, deformity correction, and ROM as a result of the treatment. These findings provided important insights into the management of Perthes disease and highlighted the need for individualized treatment strategies to achieve optimal patient outcomes. Keywords: Harris Hip Score; Perthes Disease; Orthopedic deformities; Orthotic devices; Radiological examination.

Survivorship and Clinical Outcomes of Primary Total Knee Arthroplasty Performed in Patients 35 Years of Age and Younger