Osteonecrosis Of Femoral Head Research Articles

Immune checkpoint inhibitors (ICIs) have dramatically reshaped the therapeutic landscape of oncology, offering long-term survival benefits across multiple tumor types. However, ICIs are associated with a broad range of immune-related adverse events (irAEs), most of which are now well characterized and manageable. A subset of irAEs, however, remains rare, unpredictable, and poorly understood, both in terms of clinical presentation and pathogenesis. Here, we describe the case of a patient with advanced melanoma treated with combined anti-CTLA-4 and anti-PD-1 therapy who developed severe left hip pain during treatment. Imaging findings were initially suggestive of osteonecrosis of the femoral head. However, histopathological analysis of the resected femoral head revealed a dense lymphoplasmacytic infiltrate with fibrosis and vascular congestion, without evidence of bone necrosis, consistent with an immune-mediated osteitis. To our knowledge, this represents the first documented case of direct immune-related inflammation selectively affecting bone tissue during ICI therapy. Recognition of such atypical skeletal irAEs may be critical for improving diagnosis and management strategies in the expanding field of immuno-oncology.

IntroductionLegg-Calvé-Perthes disease (LCPD) is juvenile idiopathic femoral head avascular necrosis with unclear pathophysiology. We aimed to identify circulating metabolic biomarkers and clarify the roles of peripheral inflammation and vascular/endothelial dysfunction in LCPD, and to evaluate the protective potential of 3-ketoglucose (3-KG) and sanguinarine (SANG).MethodsPeripheral blood from children with LCPD (n=36) and healthy controls (n=6) underwent untargeted LC-MS metabolomics with differential and pathway analyses. Candidate metabolites (3-KG, SANG) were tested in LPS-challenged HUVECs for effects on viability, ROS, IL-1β/IL-6/TNF-α, and NF-κB/eNOS/VCAM-1 (RNA-seq, qPCR, Western blot, immunofluorescence). In vivo validation used a steroid/LPS-induced rat model of femoral head osteonecrosis assessing histology, adipogenesis, serum ALP/TG, and Nos3/Vcam1/Nfkb1 expression.ResultsThirty-eight metabolites differed significantly between LCPD and controls; 3-KG and SANG were upregulated, whereas several metabolites including N-methyl-D-aspartate were downregulated, mapping to inflammatory and oxidative-stress pathways. Both 3-KG and SANG dose-dependently mitigated LPS-induced HUVEC injury by restoring viability, lowering ROS and pro-inflammatory cytokines, and normalizing NF-κB/eNOS/VCAM-1 at mRNA and protein levels, with SANG showing greater potency. In rats, both compounds ameliorated bone loss and adipogenesis, increased ALP, reduced TG, and reversed MPS-induced changes in Nos3, Vcam1 and Nfkb1.DiscussionThis work defines a peripheral “metabolomic fingerprint” of LCPD and links systemic metabolic alterations to endothelial inflammation/dysfunction. 3-KG and SANG exhibit endothelial-protective activity in vitro and in vivo, supporting their promise as diagnostic biomarkers and therapeutic candidates. Larger, longitudinal cohorts are needed to validate these signatures and clarify stage-specific dynamics.

BackgroundIcariin (ICA) has showed the beneficial effects on preventing the occurrence of steroid-induced osteonecrosis of the femoral head (SONFH) through enhancing bone formation and remodeling. In addition, the glucocorticoid-induced inhibition of cell proliferation and apoptosis are closely related to the pathogenesis of SONFH. In view of this, the present study was first designed to observe the effect of ICA on dexamethasone (Dex)-induced BMSCs and further reveal the relevant molecular mechanism. Furthermore, due to that the traditional oral administration of ICA is difficult to be absorbed and has a low bioavailability, the sustained-release ICA delivery system co-loaded thermosensitive PLGA-PEG-PLGA hydrogels was constructed, and the efficiency of this drug delivery system for the treatment of early SONFH was evaluated in rats model.MethodsThe anti-apoptotic effect of ICA on the Dex-induced BMSCs was observed by crystal violet staining assay, Hoechst 33342 staining and flow cytometry analysis. Meanwhile, the protein expression levels of Akt/Bad/Bcl-2 signaling pathway were detected by Western blotting. Moreover, the sustained-release ICA delivery system co-loaded thermosensitive PLGA-PEG-PLGA hydrogels was constructed, and the sol-gel transition, in vitro degradation, as well as the sustained release of ICA from this drug delivery system was evaluated by a high performance liquid chromatography (HPLC) system. Ultimately, the sustained-release 2000 μM ICA delivery system co-loaded 25 wt% thermosensitive PLGA-PEG-PLGA hydrogels was injected into the femoral head and medullary cavity after core decompression (CD) to systematically assess the efficiency of this drug delivery system for the treatment of SONFH in rats model by MRI, Micro-CT and histological analysis.ResultsICA could rescue BMSCs from Dex-induced apoptosis through promoting the phosphorylation of Akt/Bad/Bcl-2 signaling pathway. Furthermore, the degradation of copolymer was related to the ICA concentration, and the sustained-release effect of this delivery system in vitro was influenced by the drug and gel concentration. Importantly, the local injection of the sustained-release ICA delivery system co-loaded thermosensitive PLGA-PEG-PLGA hydrogels combined with core decompression (CD) could significantly relieve the bone marrow edema, augment the trabeculae bone, reduce the empty lacunae, and decrease the accumulation of adipocyte while increasing the expression of Runx-2 and inhibiting the expression of PPAR-γ in the femoral head.ConclusionOur data showed that local injection of this sustained-release drug delivery system combined with CD could significantly relieve the glucocorticoid-induced early osteonecrosis in the rats model with SONFH by increasing the residence time of ICA in the necrotic area of femoral head to maximize the anti-apoptotic, pro-osteogenic and anti-adipogenic effects of ICA.

An injectable hydrogel loaded with miRNA nanocarriers promotes vessel-associated osteoclast (VAO)-mediated angiogenesis and bone regeneration in osteonecrosis of the rat femoral head.

Mst1 inhibition mitigates steroid-induced femoral head osteonecrosis by modulating autophagy in bone microvascular endothelial cells.

To investigate the effect of hip component position on gait after primary THA in patients with unilateral femoral head necrosis. A total of 40 patients underwent primary THA due to unilateral femoral head osteonecrosis were enrolled in this study. The gait data and CT images of the hip and knee joints were obtained before and 3 months after operation. The changes of plantar gait before and after operation were compared, and the correlation between postoperative femoral anteversion angle and acetabular anteversion angle and postoperative gait data were analyzed. The postoperative acetabular anteversion angle was significantly higher than that before operation (p = 0.032), and there was no significant change in the femoral anteversion angle (p = 0.221). Compared with the preoperative, the postoperative gait speed (p = 0.002), stride frequency (p = 0.010), stride length (p = 0.013), touchdown angle (p = 0.011) and ground beat speed (p = 0.009) were significantly improved, and the postoperative foot offset angle was significantly reduced (p = 0.002). Spearman correlation analysis was used to analyze the correlation between postoperative femoral anteversion angle, acetabular anteversion angle and postoperative plantar gait data. The results showed that the magnitude of postoperative femoral anteversion angle was correlated with postoperative beat ground speed (p = 0.035) and postoperative step frequency (p = 0.027). For patients with unilateral femoral head necrosis undergoing primary THA, the postoperative acetabular anteversion angle was significantly correlated with postoperative foot offset angle and postoperative touchdown angle. The larger the postoperative acetabular anteversion angle was, the larger the postoperative foot offset angle was and the smaller the postoperative touchdown angle was.

Core decompression (CD) is a minimally invasive procedure widely used to treat early-stage osteonecrosis of the femoral head (ONFH). However, CD alone often yields suboptimal outcomes in promoting bone regeneration in necrotic lesions, highlighting the need for novel therapeutic approaches. In this study, we evaluated the combined effects of CD surgery and local administration of AKDS001, a small-molecule EP4 receptor agonist, in a canine ONFH model. AKDS001 was incorporated into biocompatible, biodegradable polylactic-coglycolic acid microspheres (AKDS001 MSs) for sustained local drug release. The bone-regenerative effects of local administration of AKDS001 MSs combined with CD surgery were evaluated in intact canines or a canine ONFH model, induced by ethanol injection into the femoral head. Safety and local tolerability of the therapy was also investigated in the model. AKDS001 MSs enhanced bone formation in intact dog femurs compared to CD only or MSs without AKDS001. In the ONFH model, CD alone resulted in limited bone repair at 12 weeks postsurgery. In contrast, compared with CD alone, the combination of AKDS001 MSs and CD dose-dependently increased the bone volume, bone mineral density, and tissue mineral density in the CD tunnel. Histological analyses further revealed significant amelioration of the necrotic lesions. Importantly, no systemic or local adverse effects were observed. In conclusion, local administration of AKDS001 MSs combined with CD surgery significantly enhanced bone regeneration in necrotic lesions in a canine ONFH model, demonstrating both efficacy and favorable safety with local tolerability.

This study aimed to identify candidate diagnostic biomarkers for steroid-induced osteonecrosis of the femoral head (SONFH). Two datasets were downloaded from the Gene Expression Omnibus for analyses of differentially expressed genes (DEGs) and lipid scores in SONFH and control groups and a weighted gene co-expression network analysis. Overlap between genes in the disease-related module, DEGs, and lipid metabolism-related genes was evaluated to obtain lipid metabolism-related DEGs. A diagnostic model was constructed and evaluated using a nomogram analysis and calibration curves. Correlations between immune cells and lipid metabolism-related DEGs in the model were evaluated. In total, 1,724 DEGs were screened between the SONFH and control groups. Seven SONFH-related modules and 18 lipid metabolism-related DEGs were identified. A total of six optimized genes, CDK8, CHPT1, DPEP3, ORMDL3, PIP5K1B, and PPT2, were obtained. A model based on these genes had good diagnostic performance for SONFH in GSE123568 and GSE74089. The six genes were significantly related to two immune cell subsets, myeloid dendritic cell activated and neutrophil. These six genes may be novel biomarkers for SONFH and the combination is a potential diagnostic signature.

The study aims to assess the effect of hyperbaric oxygen therapy (HBOT) on the radiological and clinical outcomes in patients with early Osteonecrosis of the femoral head (ONFH) at mid-term follow-up. A prospective observational study was conducted on patients with Osteonecrosis of the femoral head (ONFH). ONFH was diagnosed based on plain radiographs and MRI of the bilateral hips. ARCO stages 1-3A of ONFH patients were included with non-traumatic etiologies. Each patient received 5 sessions of HBOT per week for a total of 35 sessions. Repeat MRI was done within 6weeks of completion of HBOT sessions, at 1year and 2years of follow-up. The pre-treatment and last follow-up (2years) clinical (Harris Hip Scores, VAS Scores) and radiological parameters (JIC Classification, ARCO Staging, Modified Kerboul Angle, Bone marrow edema severity) were compared. At the final follow-up, there was a significant improvement in the mean Harris Hip Score (p = 0.001) and VAS Score (p = 0.001). There was also a significant improvement in the JIC classification (p = 0.03), Modified Kerboul Angle (p = 0.001) and Bone marrow edema grading (p = 0.001) at the final follow-up. HBOT provides good clinical and radiological improvement and is an effective, safe, and non-invasive treatment for patients in the early stages of ONFH. Its role in the early collapse stage needs further validation by higher-level, prospective, large-scale RCTs.

Special Considerations Before Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis With a Recent Corticosteroid Injection.

Background/Objectives: Osteonecrosis of the femoral head (ONFH) is a common condition in hip surgery, which is characterized by the death of bone cells due to disruption of the blood supply and ultimately irreversible destruction of the hip joint. As a result of the COVID-19 pandemic, a significant increase in the incidence of ONFH has been identified. To better understand the pathogenesis of ONFH in the context of COVID-19, our research aimed to determine pathomorphological changes in articular tissues specific to post-COVID-19 ONFH. Methods: Using morphological, morphometric, and statistical methods, the femoral heads after hip arthroplasty were retrospectively studied in patients with post-COVID-19 ONFH (n = 41) compared to a non-COVID-19 group of patients (n = 47). Results: Our results revealed that the key morphofunctional biomarkers of post-COVID-19 ONFH were clusters of mast cells, extensive areas of fibrosis, numerous arterial and venous thrombi, and giant cell granulomas. The potential relationship of those morphological features with the action of the SARS-CoV-2 coronavirus was discussed. Conclusions: Mast cells have been proposed as the leading players that may trigger the main molecular and cellular mechanisms in the development of post-COVID-19 ONFH and can be considered a diagnostic sign of the disease.

ABSTRACTGlucocorticoids (GCs) are steroid hormones commonly used to treat inflammation, autoimmune diseases, and malignant tumors. By inhibiting bone formation and promoting osteoclast apoptosis, GCs significantly accelerate the onset of femoral head osteonecrosis, leading to structural changes, collapse, or destruction of bone. The mechanisms and pathways involved in glucocorticoid‐induced osteonecrosis (GION) may offer insights for developing new treatments. The pathogenesis of GION is complex and multifaceted, involving multiple pro‐apoptotic signaling pathways that collectively drive bone degradation and osteonecrosis. Specifically, key pathways implicated in GION, including 11β‐HSD enzymes, CD95/CD95L, STAT1‐caspase 3, the Bcl‐2 subfamily, PI3K/Akt, and Wnt/β‐Catenin, represent potential therapeutic targets for preventing and treating GION.

This study aimed to compare the postoperative radiological and functional outcomes of posterior wall acetabular fractures with and without marginal impaction. Patients who underwent surgical treatments for posterior wall acetabular fractures at a single level I trauma center between January 2013 and June 2022 were enrolled. Seventeen patients with marginal impaction were classified into group I, and the remaining 24 were classified into group II. Immediate postoperative reduction quality was confirmed using computed tomography (CT), final follow-up results were evaluated using simple x-ray. Heterotopic ossification (HO), post-traumatic osteonecrosis of femoral head (ONFH), rate of conversion to total hip arthroplasty (THA), and Harris Hip Score (HHS) also compared between the two groups. Marginal impaction occurred in 41.5% of acetabular fractures involving the posterior wall. Posterior dislocation at initial trauma was significantly lower in group I than in group II. There were no significant differences in the postoperative quality of reduction between the two groups. HO in five patients in each group, but there was no significant difference. There was no post-traumatic ONFH and conversion to THA in total population at a minimum 2-year follow up. There was no significant difference in term of HHS. It is important to carefully interpret the preoperative CT images to identify the marginal impaction and to achieve anatomical reduction and satisfactory surgical outcomes.

Steroid-induced osteonecrosis of femoral head (SONFH) is a disease characterized by femoral head collapse and local pain caused by excessive use of glucocorticoids. Peroxisome proliferator-activated receptor-γ (PPARγ) is mainly expressed in adipose tissue. Wnt/β-catenin, AMPK and other related signaling pathways play an important role in regulating adipocyte differentiation, fatty acid uptake and storage. Bone marrow mesenchymal cells (BMSCs) have the ability to differentiate into adipocytes or osteoblasts, and the use of hormones upregulates PPARγ expression, resulting in BMSCs biased towards adipogenic differentiation. The increase of adipocytes affects the blood supply and metabolism of the femoral head, and the decrease of osteoblasts leads to the loss of trabecular bone, which eventually leads to partial or total ischemic necrosis and collapse of the femoral head. MicroRNAs (miRNAs) are a class of short non-coding RNAs that regulate gene expression by inhibiting the transcription or translation of target genes, thereby affecting cell function and disease progression. Studies have shown that miRNAs affect the progression of SONFH by regulating PPARγ lipid metabolism-related signaling pathways. Therefore, it may be an accurate and feasible SONFH treatment strategy to regulate adipogenic-osteoblast differentiation in BMSCs by targeted intervention of miRNA differential expression to improve lipid metabolism. In this paper, the miRNA-mediated PPARγ-related signaling pathways were classified and summarized to clarify their effects on lipid metabolism in SONFH, providing a theoretical reference for miRNA targeted therapy of SONFH, and then providing scientific evidence for SONFH precision medicine.

To investigate the effectiveness of Holosight robotic navigation-assisted percutaneous cannulated screw fixation for femoral neck fractures. A retrospective analysis was conducted on 65 patients with femoral neck fractures treated with cannulated screw fixation between January 2022 and February 2024. Among them, 31 patients underwent robotic navigation-assisted screw placement (navigation group), while 34 underwent conventional freehand percutaneous screw fixation (freehand group). Baseline characteristics, including age, gender, fracture side, injury mechanism, Garden classification, Pauwels classification, and time from injury to operation, showed no significant differences between the two groups ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time, and complications were recorded and compared, and hip function was evaluated by Harris score at last follow-up. Postoperative anteroposterior and lateral hip X-ray films were taken to assess screw distribution accuracy, including deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex. No significant difference was observed in operation time between the two groups ( P>0.05). However, the navigation group demonstrated superior outcomes in intraoperative blood loss, fluoroscopy frequency, deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex ( P<0.05). No incision infections or deep vein thrombosis occurred. All patients were followed up 12-18 months (mean, 16 months). In the freehand group, 1 case suffered from cannulated screw dislodgement and nonunion secondary to osteonecrosis of femoral head at 1 year after operation, 1 case suffered from screw penetration secondary to osteonecrosis of femoral head at 5 months after operation; and 1 case suffered from nonunion secondary to osteonecrosis of femoral head at 6 months after operation in the navigation group. All the 3 patients underwent internal fixators removal and total hip arthroplasty. There was no significant difference in the incidence of complications between the two groups ( P>0.05). The fracture healing time and hip Harris score at last follow-up in the navigation group were significantly better than those in the freehand group ( P<0.05). Compared to freehand percutaneous screw fixation, Holosight robotic navigation-assisted cannulated screw fixation for femoral neck fractures achieves higher precision, reduced intraoperative radiation exposure, smaller incisions, and superior postoperative hip function recovery.

Abstract Osteonecrosis of the femoral head is a devastating disease that accounts for 10–15% of all hip arthroplasty cases in the USA, eventually leading to femoral head collapse and joint destruction. Even the current forms of treatment only slightly slow down the progression of the disease itself. This article describes a modified lightbulb technique, which perfects the method, the instrument, and the flap used in order to ensure hip musculature preservation and improved outcomes. With the direct anterior approach, there is no need to perform surgical dislocation, so the time of the surgery is reduced, as well as the risk of vascular injury. The necrotic bone can be precisely removed using custom-made offset curettes, and a bone graft substitute and autograft can be placed under C-arm guidance. This technique may be beneficial in treating early osteonecrosis of the femoral head by reducing operative time and reducing the risk of complications related to surgical dislocation.

Osteonecrosis of the femoral head (ONFH) is a debilitating condition that often leads to femoral head collapse due to insufficient blood supply and impaired bone regeneration. However, effective treatment options for this condition are limited. This study explored a novel fish collagen (FC) scaffold combined with adipose-derived stem cells (ADSCs) to enhance osteogenesis and angiogenesis in ONFH. ADSCs were isolated and cultured on FC scaffolds to evaluate their biocompatibility and differentiation capacity. Osteogenic and angiogenic differentiation potentials were assessed in vitro, and the FC/ADSC combination was further evaluated in vivo using a rat model of ONFH. The molecular mechanisms were investigated via gene expression profiling and Hippo signaling pathway analysis. The FC scaffolds promoted ADSCs adhesion, proliferation, and migration without cytotoxicity. In vitro, FC/ADSCs significantly enhanced mineralization and capillary-like structure formation compared to the controls. FC/ADSCs improved bone regeneration and neovascularization in the femoral head in vivo, as confirmed by histological and immunohistochemical analyses. Mechanistically, the Hippo pathway is activated, increasing HIF-1α expression, which enhances osteogenic and angiogenic differentiation. FC scaffolds combined with ADSCs provide a promising therapeutic strategy for ONFH by facilitating bone regeneration and vascularization through the p-YAP/HIF-1α/VEGF axis. This scaffold-cell approach represents a potential advancement in ONFH treatment.

This study aimed to develop an X-ray radiomics model for predicting collapse of early-stage osteonecrosis of the femoral head (ONFH). A total of 87 patients (111 hips; training set: n = 67, test set: n = 44) with non-traumatic ONFH at Association Research Circulation Osseous (ARCO) stage II were retrospectively enrolled. Following data dimensionality reduction and feature selection, radiomics models were constructed based on anteroposterior (AP), frog-lateral (FL), and AP + FL combined view using random forest (RF), support vector machine (SVM), and stochastic gradient descent (SGD). After the optimal radiomics model was selected based on areas under the curve (AUC), its performance on the test set was compared with that of orthopaedists using receiver operating characteristic (ROC) curves and confusion matrices. Among all radiomics models, the SVM-based AP + FL combined view model (AP + FL-Rad_SVM) achieved the highest individual performance demonstrating an AUC of 0.904 (95% CI 0.829 –0.978) in the test set, which was significantly better than that of three attending surgeons (p = 0.014, 0.004, and 0.045, respectively). The SVM model based on AP + FL views of hip X-ray exhibited excellent ability in predicting the collapse of ONFH and showed superior performance compared with less experienced orthopaedic surgeons. This model may inform clinical decision-making for early-stage ONFH.

BACKGROUND: Osteonecrosis of the femoral head is a severe and rapidly progressive degenerative-dystrophic disorder and is commonly detected in children professionally engaged in rhythmic gymnastics. It is characterized by destructive changes in the femoral head, resulting in hip joint function impairment and, consequently, poor clinical outcomes. The radiographic anatomy of the hip joints is insufficiently studied, especially considering the impact of intense and specific physical loads, course and progression of the disease, and reasons behind its delayed diagnosis and late initiation of treatment. AIM: To provide a clinical and radiological characterization of the hip joints in young rhythmic gymnasts diagnosed with idiopathic avascular necrosis of the femoral head and identify factors contributing to delayed diagnosis and late treatment initiation. METHODS: Medical histories and imaging findings of 45 young rhythmic gymnasts aged 12–17 years diagnosed with idiopathic avascular necrosis of the femoral head were analyzed. RESULTS: Most patients exhibited a severe clinical course due to total or subtotal involvement of the femoral head. Distinctive anatomical features of the hip joint in young rhythmic gymnasts included dysplastic morphology with impaired stability indices, valgus epiphyseal formation resembling a Kalamchi type II deformity, and a tendency toward acetabular retroversion. These characteristics contributed to the development of pathological changes, such as femoral head extrusion and deformation. Delayed diagnosis and initiation of treatment was due to insufficient awareness of this pathology among parents, coaches, and physicians; gradual development of clinical symptoms without a history of overt trauma; and diagnostic errors during the early stages of the disease. CONCLUSION: In adolescents, their congenital anatomical features of the hip joint contribute to a more severe course of avascular necrosis of the femoral head. Early differential diagnosis of hip pain in gymnasts, including the use of magnetic resonance imaging, is crucial to exclude femoral head osteonecrosis.

To compare the effects of double-channel core decompression (CD) combined with medullary cavity irrigation with those of simple CD on progression of collapse and clinical outcomes in non-traumatic osteonecrosis of the femoral head (ONFH). A retrospective analysis was conducted on the clinical data of 19 patients (30 hips) with non-traumatic ONFH who underwent double-channel CD combined with medullary cavity irrigation and admitted between January 2024 and October 2024 (CD+irrigation group). According to a 1: 2 ratio, 54 patients (60 hips) who underwent simple CD and were matched in terms of age, gender, and body mass index (BMI) were included as the control (CD group). There was no significant difference in baseline data such as age, gender, BMI, affected side, ONFH type, preoperative Association Research Circulation Osseous (ARCO) stage, bone marrow edema stage, visual analogue scale (VAS) score for pain, and Harris score between the two groups ( P>0.05). The postoperative discharge time and occurrence of complications were recorded for both groups. The VAS scores before operation and at discharge after operation were compared, and the differences between pre- and post-operation (change values) were calculated for intergroup comparison. The Harris scores before operation and at discharge and 3 months after operation were also compared. During follow-up, X-ray film, CT, and MRI were performed for reexamination. The ARCO stage and bone marrow edema stage were evaluated at 3 months after operation and compared with those before operation to determine whether there was radiological progression or relief. All incisions in both groups healed by first intention after operation, with no infection, femoral neck fracture, or other operation-related complications. All patients were followed up, and the follow-up time of the CD+irrigation group was (146.8±27.7) days, and that of the CD group was (164.3±48.2) days; there was no significant difference between the two groups ( t=1.840, P=0.069). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). At discharge after operation, the VAS score of the CD+irrigation group was significantly lower than that of the CD group ( P<0.05), and the change value was significantly higher than that of the CD group ( P<0.05). The Harris scores at discharge and 3 months after operation in the CD+irrigation group were significantly higher than those in the CD group ( P<0.05). The Harris score gradually increased with time, and the differences between different time points were significant ( P<0.05). Radiological reexamination showed that there was no significant difference in the ARCO stage and the incidence of radiological progression between the two groups at 3 months after operation ( P>0.05); however, the bone marrow edema stage and the degree of bone marrow edema relief in the CD+irrigation group were better than those in the CD group, with significant differences ( P<0.05). Double-channel CD combined with medullary cavity irrigation can significantly alleviate hip joint pain and improve joint function in patients with non-traumatic ONFH, reduce the degree of bone marrow edema in the femoral head, and delay the progression of ONFH.