Abstract:

Objective

To explore the overall knowledge structure， global research status， and development trends of core decompression for femoral head necrosis.Based on cases in our center， the clinical efficacy and value of this surgical technique were verified.

Methods

Relevant literatures on core decompression for osteonecrosis of the femoral head were searched through the Web of Science core collection database， with a time span from database establishment to January 1， 2024.VOSviewer and Scimago software were used to analyze the co authorship status， regional distribution of research results， hot topics， and time zone distribution of research hotspots in the field of core decompression technology in the treatment of osteonecrosis of the femoral head.And we generated a visual knowledge graph.The current status and development trends of hip preservation therapy for necrosis of the femoral head were comprehensively evaluated， and bibliometric results were correlated with the real-world data.A retrospective analysis was conducted on 27 patients with ARCO stage I-IIIA who underwent simple core decompression or core decompression combined with bone grafting in our hospital from October 2017 to June 2023.We compare the visual analog scale （VAS） and Harris hip joint score in patients undergoing unilateral core decompression combined with bone grafting before surgery， 3 months after surgery， and at the last follow-up after surgery.And we evaluate the collapse of the femoral head based on preoperative and postoperative X-ray， and evaluate the situation of reoperation.

Results

This study included 859 academic papers and reviews， with Chinese scholars having the highest total number of publications， followed by American scholars.However， American scholars Mont and Michael A.had the highest number of individual publications （41）， while American scholars Hungerford ds.had the highest number of citations （178.5 per article）.The top 10 research institutions in terms of publication volume have the highest number of Chinese institutions， but the articles published by Sinai Hospital have been cited 101.13 times， which is more recognized by the academic community.Keyword analysis suggests that the current research focus is not limited to the study of core decompression technology itself， but more on the selection of bone grafting materials and the study of cell therapy.Core decompression combined with bone grafting and cell therapy is currently a hot topic.A total of 27 patients with femoral head necrosis were included as the study subjects in this study， with a total of 32 hip joints undergoing core decompression surgery.Among them， 14 hip joints underwent simple core decompression surgery， and 18 hip joints underwent core decompression combined with bone grafting surgery.Among the 14 hip joints that underwent simple core decompression surgery， 7 femoral heads experienced another collapse with a 50%collapse rate， and 6 joints underwent total hip replacement with a 42.86% reoperation rate.Among the 18 hip joints undergoing core decompression and bone grafting surgery， 5 had femoral head collapse， with a collapse rate of 27.78%， and 3 joints underwent total hip replacement with a hip joint reoperation rate of 16.67%.9 patients who underwent unilateral core decompression combined with bone grafting surgery and did not undergo further surgery achieved good clinical efficacy after surgery.The Harris score and VAS score of those patients improved significantly after surgery （P＜0.01）.

Conclusion

Core decompression for necrosis of the femoral head has received attention from the academic community， and China has become a core force in this field with certain advantages.Bone grafting materials and regenerative cell therapy are current research hotspots that have attracted much attention from the academic community.Core decompression combined with bone grafting and cell therapy is an effective treatment for early and mid stage necrosis of the femoral head， which can improve hip preservation rate， delay or even avoid patients undergoing total hip replacement surgery.

Key words: Femoral head necrosis, Core decompression surgery, Bibliometrics, Visual analysis