Abstract
BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a progressive and disabling disease that commonly affects young and middle-aged adults. Without timely treatment, it often progresses to femoral head collapse and hip dysfunction, ultimately requiring total hip arthroplasty. Although core decompression (CD) and superselective intra-arterial perfusion have been applied clinically, their long-term efficacy as monotherapy remains limited, and the clinical value of combining these approaches has not been fully clarified. OBJECTIVES: This study aimed to evaluate the clinical efficacy of CD combined with superselective intra-arterial perfusion in the treatment of ONFH, and to identify key prognostic factors influencing therapeutic outcomes. METHODS: This study enrolled 145 patients in the CD group, 123 in the SIAE group, and 89 in the combined group. Preoperative baseline characteristics, postoperative Harris Hip Scores (HHS), Visual Analog Scale (VAS) scores, MRI-derived collapse rates, and complication rates were compared. Patients were stratified into effective and non-effective groups to analyze risk factors. Receiver operating characteristic (ROC) curves assessed predictive performance. RESULTS: Baseline characteristics, including sex, age, body mass index (BMI), Association Research Circulation Osseous (ARCO) staging, etiology, and lesion location, showed no intergroup differences. The combined group exhibited superior postoperative HHS improvement, VAS reduction, and collapse rate mitigation compared to monotherapy groups. Complication rates were lowest in the combined group (2.2%) versus CD (7.6%) and SIAE (12.2%) groups. The combined group had the highest efficacy rate, with non-traumatic etiology and marginal necrosis predominating in the effective group. Logistic regression identified surgical approach, BMI, etiology, and lesion location as independent predictors of efficacy. Surgical approach demonstrated the highest predictive power (area under the curve (AUC) = 0.7838, sensitivity 83.75%, specificity 60.41%), while the constant term achieved optimal performance (AUC = 0.8549). CONCLUSION: CD combined with SIAE significantly enhances clinical outcomes, alleviates pain, reduces collapse rates, and minimizes complications in ONFH. Surgical approach, BMI, etiology, and lesion location critically influence efficacy. The combined strategy represents a superior intervention with promising clinical applicability.