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
- 1School of Health Science and Engineering, University of Shanghai for Science and Technology, Yangpu, Shanghai, China
- 2Department of Pediatric Operating Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
- 3Department of Pediatric Orthopaedic, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
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.
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BibTeX
@article{gao2026clinical,
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}},
author = {Birong Gao and Birong Gao and Weijia Feng and Ting Chen},
journal = {Frontiers in Physiology},
year = {2026},
month = nov,
doi = {10.3389/fphys.2026.1954397},
url = {https://doi.org/10.3389/fphys.2026.1954397},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Birong Gao
AU - Birong Gao
AU - Weijia Feng
AU - Ting Chen
PY - 2026
DA - 2026/11/04
JO - Frontiers in Physiology
DO - 10.3389/fphys.2026.1954397
UR - https://doi.org/10.3389/fphys.2026.1954397
AB - 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.
SN - 1664-042X
ER -