Abstract Core decompression is a standard treatment for early-stage osteonecrosis of the femoral head (ONFH). Synthetic bone substitutes such as biphasic calcium composite (CaSO₄/CaPO₄) and bioactive glass have been used to augment the procedure, but their clinical benefit remains uncertain. We retrospectively reviewed 83 hips (78 patients) treated with core decompression, with or without augmentation, from 2013 to 2024 at two hospitals. Patients received biphasic calcium, bioactive glass, or no graft. The primary endpoint was conversion to total hip arthroplasty (THA). Kaplan–Meier survival and multivariate logistic regression were performed. THA occurred in 38.9% of biphasic calcium cases, 42.9% with bioactive glass, and 42.1% in controls (P = .959). Kaplan–Meier analysis showed no significant survival difference (log-rank P = .707). BMI ≥25 predicted higher THA risk (OR 7.98; 95% CI 2.03–31.32; P = .003). Compared with alcohol-related or other aetiologies, steroid-associated ONFH was associated with a lower risk of THA conversion (adjusted OR 0.11; P = .020). Synthetic augmentation did not reduce THA conversion after core decompression for ONFH. Elevated BMI was a strong predictor of failure, underscoring the importance of patient selection and modifiable risk factors in hip-preserving surgery.
Kuo et al. (Fri,) studied this question.