The Effect of Systemic Steroid Use on the Success of Core Decompression in Non-Traumatic Early-Stage Femoral Head Osteonecrosis

Objectives: Systemic corticosteroid use is a well-established risk factor for non-traumatic osteonecrosis of the femoral head (ONFH). However, its impact on the clinical outcomes of joint-preserving procedures, such as core decompression (CD), remains uncertain. This study aimed to evaluate whether systemic steroid exposure influences the success of CD in patients with early-stage ONFH.
Methods: This retrospective cohort study included 49 hips from 41 patients with Ficat stage IIa ONFH who underwent isolated CD between 2013 and 2021. Patients were stratified into two groups according to systemic corticosteroid use within one year prior to diagnosis. Demographic and radiologic data, including modified Kerboul angle and stage, were collected. Treatment success was defined as the absence of femoral head collapse or conversion to total hip arthroplasty at the final radiologic follow-up. Outcomes were compared between steroid users and non-users using t-tests, Mann–Whitney U, chi-square, and Fisher’s exact tests, as appropriate.
Results: Overall, treatment success was achieved in 63.3% of hips. The success rate was 70.4% in steroid users and 54.5% in non-users, but this difference was not statistically significant (p=0.372). Baseline radiologic parameters, including modified Kerboul angle and stage, did not differ significantly. Sex distribution differed significantly (p=0.003), while age, follow-up duration, and bilaterality were comparable.
Conclusion: Systemic corticosteroid use was not significantly associated with worse radiologic outcomes following CD in early-stage ONFH. These findings support CD as a viable joint-preserving treatment in appropriately selected patients, irrespective of prior steroid exposure.

Keywords: Femoral head, glucocorticoids, osteonecrosis, surgical decompression, treatment outcome