Development and validation of a nomogram for predicting the probability of arthroplasty in patients with osteonecrosis of the femoral head after fibular strut grafting.
- 1Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- 2Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- 3Department of Orthopaedics, Foshan Traditional Chinese Medicine Hospital, Foshan, China.
Abstract
Background
While fibular strut grafting (FSG) is effective for osteonecrosis of the femoral head (ONFH), some patients still progress to total hip arthroplasty (THA). This study aimed to identify risk factors for FSG failure and develop a validated nomogram to predict the mid-long term survival rate after FSG.Methods
Data on patients with ONFH who underwent FSG were collected in our institution from February 2009 to December 2018. Independent predictors were identified using univariable and multivariable Cox regression analyses. Kaplan-Meier analysis was used to estimate survival after FSG. A nomogram predicting failure, defined as conversion to THA, was developed from the selected predictors and internally validated using the concordance index (C index), the Receiver Operating characteristic (ROC) curves, and calibration curves.Results
Among 416 eligible patients, 55 converted to THA. The 5-, 8-, and 10-year survival rates after FSG were 89.7%, 83.6%, and 82%, respectively. Age, smoking, Fibrinogen (FIB), hypertension, diabetes, and ARCO stage were independent predictors of failure. Subsequently, a nomogram model was developed incorporating 7 predictors (including JIC classification). Its C-index was 0.734 (95%CI 0.66-0.80). The area under the curves (AUCs) of the nomogram predicted for 5-, 8-, and 10-year were 0.727, 0.735, and 0.735, respectively. Predicted and observed survival rates agreed closely.Conclusion
The internal validation shows that the nomogram model has acceptable discriminative ability and good accuracy. It may support clinical application, effectively optimize perioperative management, and help doctors and patients to avoid FSG failure.
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BibTeX
@article{zhang2026development,
title = {{Development and validation of a nomogram for predicting the probability of arthroplasty in patients with osteonecrosis of the femoral head after fibular strut grafting.}},
author = {Haitao Zhang and Zequan Luo and Jiayi Zhu and Guowen Bai and Jiaming Zeng and Ke Jie and Qiang Wan and Xinyu Qi and Jie Li and Jianchun Zeng and Zhiyuan Wang and Kaifeng Cheng and Hang Quan and Yirong Zeng and Wenjun Feng and Yijin Li and Jinlun Chen},
journal = {Annals of medicine},
year = {2026},
month = oct,
doi = {10.1080/07853890.2026.2734061},
url = {https://europepmc.org/article/MED/42851017},
note = {CC BY},
}
RIS
TY - JOUR
TI - Development and validation of a nomogram for predicting the probability of arthroplasty in patients with osteonecrosis of the femoral head after fibular strut grafting.
AU - Haitao Zhang
AU - Zequan Luo
AU - Jiayi Zhu
AU - Guowen Bai
AU - Jiaming Zeng
AU - Ke Jie
AU - Qiang Wan
AU - Xinyu Qi
AU - Jie Li
AU - Jianchun Zeng
AU - Zhiyuan Wang
AU - Kaifeng Cheng
AU - Hang Quan
AU - Yirong Zeng
AU - Wenjun Feng
AU - Yijin Li
AU - Jinlun Chen
PY - 2026
DA - 2026/10/08
JO - Annals of medicine
DO - 10.1080/07853890.2026.2734061
UR - https://europepmc.org/article/MED/42851017
AB - Background While fibular strut grafting (FSG) is effective for osteonecrosis of the femoral head (ONFH), some patients still progress to total hip arthroplasty (THA). This study aimed to identify risk factors for FSG failure and develop a validated nomogram to predict the mid-long term survival rate after FSG.Methods Data on patients with ONFH who underwent FSG were collected in our institution from February 2009 to December 2018. Independent predictors were identified using univariable and multivariable Cox regression analyses. Kaplan-Meier analysis was used to estimate survival after FSG. A nomogram predicting failure, defined as conversion to THA, was developed from the selected predictors and internally validated using the concordance index (C index), the Receiver Operating characteristic (ROC) curves, and calibration curves.Results Among 416 eligible patients, 55 converted to THA. The 5-, 8-, and 10-year survival rates after FSG were 89.7%, 83.6%, and 82%, respectively. Age, smoking, Fibrinogen (FIB), hypertension, diabetes, and ARCO stage were independent predictors of failure. Subsequently, a nomogram model was developed incorporating 7 predictors (including JIC classification). Its C-index was 0.734 (95%CI 0.66-0.80). The area under the curves (AUCs) of the nomogram predicted for 5-, 8-, and 10-year were 0.727, 0.735, and 0.735, respectively. Predicted and observed survival rates agreed closely.Conclusion The internal validation shows that the nomogram model has acceptable discriminative ability and good accuracy. It may support clinical application, effectively optimize perioperative management, and help doctors and patients to avoid FSG failure.
SN - 0785-3890
SN - 1365-2060
ER -