Abstract
This study compares and investigates the efficacy of 2 different surgical methods for early stage femoral head necrosis and analyze the factors affecting surgical outcomes and long-term femoral head survival. A retrospective analysis was conducted on the clinical data of 48 patients (52 hips) with femoral head necrosis who underwent either the Super-Path or Watson-Jones approach from January 1, 2016, to January 1, 2024. Harris scores at multiple time points before and after surgery were compared using repeated-measures analysis of variance (ANOVA), and a COX proportional hazards model was used to analyze risk factors. The baseline data of the 2 groups were comparable (P > .05). There was no significant difference in preoperative Harris scores or scores at 3 and 12 months postoperatively (t = 0, P = 1; t = 0.719, 0.476; P = .716, .477). However, a significant difference was found at 36 months postoperatively (t = 2.118, P = .04). The preoperative stage of femoral head necrosis, patient gender, and surgical method were significant risk factors. The survival curves showed similar survival rates for the first 10 months, with no significant difference at 36 months (P = .5139). Both surgical approaches were effective in improving short-term hip function but did not show sustained long-term improvement. The Super-Path approach demonstrated better long-term outcomes compared to the Watson-Jones approach, influenced by surgical and temporal factors and preoperative staging. The COX model indicated that preoperative staging, female gender, and the surgical procedure were positively correlated with the risk of femoral head necrosis.