{
  "abstract": "BackgroundNon-traumatic osteonecrosis of the femoral head (ONFH) in children is a heterogeneous condition with variable etiologies and prognoses. Few studies have compared mid-to-long-term functional outcomes across etiologic categories in the pediatric population. This study compared clinical characteristics, treatment patterns, and 5-year hip joint function among pediatric patients with steroid-related, sickle cell disease (SCD)-associated, and idiopathic ONFH.MethodsThis retrospective cohort study included 372 pediatric patients (127 steroid-related, 89 SCD-associated, 156 idiopathic) diagnosed with ONFH between 2012 and 2020; the idiopathic group comprised children who fulfilled diagnostic criteria for Legg-Calve-Perthes disease (LCPD), and the terms idiopathic ONFH and LCPD are used synonymously throughout. The patient was the unit of analysis. Primary outcomes were the Harris Hip Score (HHS) at 5-year follow-up (assessed for native, non-replaced hips) and conversion to total hip arthroplasty (THA). Kaplan-Meier survival analysis with the log-rank test, competing-risk cumulative incidence analysis accounting for death, a linear mixed-effects model for HHS trajectories, and univariate and multivariable logistic regression were performed.ResultsThe SCD group had the worst outcomes, with a THA conversion rate of 53.9% (48/89) and a mean 5-year HHS of 65.6 +/- 19.6, compared with 33.9% (43/127) and 78.4 +/- 14.8 for the steroid-related group, and 9.6% (15/156) and 89.8 +/- 9.2 for the idiopathic (LCPD) group (all p < 0.001). In the multivariable model, SCD etiology (adjusted OR = 5.86, 95% CI: 2.60-13.24), Ficat stage III-IV (adjusted OR = 3.74, 95% CI: 1.93-7.25), and bilateral involvement (adjusted OR = 1.97, 95% CI: 1.02-3.80) were independently associated with THA conversion.ConclusionsEtiology significantly influences the clinical course and prognosis of pediatric ONFH. SCD-associated ONFH carries the worst prognosis, whereas idiopathic (LCPD) cases show the most favorable outcomes. These findings support etiology-specific management protocols.",
  "abstract_shown": true,
  "affiliations": [
    "School of Health Science and Engineering, University of Shanghai for Science and Technology, Yangpu, Shanghai, China",
    "Department of Pediatric Operating Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China",
    "Department of Pediatric Orthopaedic, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Birong Gao"
    },
    {
      "affs": [
        1
      ],
      "name": "Birong Gao"
    },
    {
      "affs": [
        2
      ],
      "name": "Weijia Feng"
    },
    {
      "affs": [
        2
      ],
      "name": "Ting Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/128xff2rkbhnx.bib",
  "cited_by": 0,
  "doi": "10.3389/fphys.2026.1954397",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fphys.2026.1954397/full",
  "id": "128xff2rkbhnx",
  "issns": [
    "1664-042X"
  ],
  "landing_url": "https://doi.org/10.3389/fphys.2026.1954397",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "QP1-981"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/128xff2rkbhnx.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T14:20:47Z",
      "native_id": "02006aa98a59486c999912abeb6d16aa",
      "source": "doaj",
      "url": "https://doi.org/10.3389/fphys.2026.1954397"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:QP1-981",
      "subfield": "physiology"
    }
  ],
  "title": "Clinical characteristics and mid-to-long-term hip joint function in children with non-traumatic osteonecrosis of the femoral head: a comparative study of steroid-related, sickle cell disease, and idiopathic etiologies",
  "title_text": "Clinical characteristics and mid-to-long-term hip joint function in children with non-traumatic osteonecrosis of the femoral head: a comparative study of steroid-related, sickle cell disease, and idiopathic etiologies",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T14:20:12Z",
  "url": "https://research.draconitic.com/paper/128xff2rkbhnx",
  "venue": "Frontiers in Physiology",
  "versions": []
}