{"id":"https://openalex.org/W7223990932","doi":"https://doi.org/10.1186/s13018-026-07315-z","title":"MRI-derived necrotic burden and subsequent femoral head collapse in osteonecrosis of the femoral head: a systematic review and meta-analysis","display_name":"MRI-derived necrotic burden and subsequent femoral head collapse in osteonecrosis of the femoral head: a systematic review and meta-analysis","publication_year":2026,"publication_date":"2026-10-27","ids":{"openalex":"https://openalex.org/W7223990932","doi":"https://doi.org/10.1186/s13018-026-07315-z"},"language":"en","primary_location":{"id":"doi:10.1186/s13018-026-07315-z","doi":"https://doi.org/10.1186/s13018-026-07315-z","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07315-z","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s13018-026-07315-z","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5152208286","display_name":"Zixuan Wang","orcid":"https://orcid.org/0009-0000-1858-4073","observed_orcids":["https://orcid.org/0009-0000-1858-4073"]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Zixuan Wang","raw_affiliation_strings":["Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China","institution_ids":["https://openalex.org/I117532281"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5100345634","display_name":"Yu Li","orcid":"https://orcid.org/0000-0001-7111-0862","observed_orcids":["https://orcid.org/0000-0001-7111-0862"]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yu Li","raw_affiliation_strings":["Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China","institution_ids":["https://openalex.org/I117532281"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5152207525","display_name":"Luntang Xie","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Luntang Xie","raw_affiliation_strings":["Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China","institution_ids":["https://openalex.org/I117532281"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159859647","display_name":"Ziming Wang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Ziming Wang","raw_affiliation_strings":["Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Guangzhou University of Chinese Medicine, 232 Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, 510006, Guangdong, China","institution_ids":["https://openalex.org/I117532281"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159858965","display_name":"Fan Yang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]},{"id":"https://openalex.org/I4210129515","display_name":"The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine","ror":"https://ror.org/036csaq39","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210129515"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Fan Yang","raw_affiliation_strings":["State Key Laboratory of Traditional Chinese Medicine Syndrome, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"State Key Laboratory of Traditional Chinese Medicine Syndrome, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","institution_ids":[]},{"raw_affiliation_string":"The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","institution_ids":["https://openalex.org/I117532281","https://openalex.org/I4210129515"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5159889052","display_name":"Qingwen Zhang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I117532281","display_name":"Guangzhou University of Chinese Medicine","ror":"https://ror.org/03qb7bg95","country_code":"CN","type":"education","lineage":["https://openalex.org/I117532281"]},{"id":"https://openalex.org/I4210129515","display_name":"The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine","ror":"https://ror.org/036csaq39","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210129515"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Qingwen Zhang","raw_affiliation_strings":["State Key Laboratory of Traditional Chinese Medicine Syndrome, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"State Key Laboratory of Traditional Chinese Medicine Syndrome, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","institution_ids":[]},{"raw_affiliation_string":"The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, 261 and 263 Longxi Avenue, Liwan District, Guangzhou, 510378, Guangdong, China","institution_ids":["https://openalex.org/I117532281","https://openalex.org/I4210129515"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5159858965","https://openalex.org/A5159889052"],"corresponding_institution_ids":["https://openalex.org/I117532281","https://openalex.org/I4210129515"],"apc_list":{"value":3090,"currency":"USD","value_usd":3090},"apc_paid":{"value":3090,"currency":"USD","value_usd":3090},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.88791157,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12209","display_name":"Bone and Joint Diseases","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12209","display_name":"Bone and Joint Diseases","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2732","display_name":"Orthopedics and Sports Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11218","display_name":"Hip disorders and treatments","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11221","display_name":"Bone health and treatments","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/avascular-necrosis-of-the-femoral-head","display_name":"osteonecrosis of the femoral head","score":0.9950000047683716},{"id":"https://openalex.org/keywords/femoral-head-collapse","display_name":"femoral head collapse","score":0.9200000166893005},{"id":"https://openalex.org/keywords/magnetic-resonance-imaging","display_name":"magnetic resonance imaging","score":0.5450000166893005},{"id":"https://openalex.org/keywords/core-decompression","display_name":"core decompression","score":0.5979999899864197},{"id":"https://openalex.org/keywords/avascular-necrosis","display_name":"avascular necrosis","score":0.6240000128746033}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9776999950408936},{"id":"https://openalex.org/C2779100257","wikidata":"https://www.wikidata.org/wiki/Q582849","display_name":"Femoral head","level":2,"score":0.7425000071525574},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.7057999968528748},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.7057999968528748},{"id":"https://openalex.org/C2777560053","wikidata":"https://www.wikidata.org/wiki/Q503629","display_name":"Avascular necrosis","level":3,"score":0.42149999737739563},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.4203999936580658},{"id":"https://openalex.org/C2780554211","wikidata":"https://www.wikidata.org/wiki/Q176503","display_name":"Femur","level":2,"score":0.40230000019073486},{"id":"https://openalex.org/C2989316616","wikidata":"https://www.wikidata.org/wiki/Q6027402","display_name":"Lower limb","level":2,"score":0.3215000033378601},{"id":"https://openalex.org/C81182388","wikidata":"https://www.wikidata.org/wiki/Q353963","display_name":"Complication","level":2,"score":0.2994999885559082},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2825999855995178},{"id":"https://openalex.org/C3018712777","wikidata":"https://www.wikidata.org/wiki/Q17081678","display_name":"Femoral shaft","level":3,"score":0.27950000762939453},{"id":"https://openalex.org/C2780312720","wikidata":"https://www.wikidata.org/wiki/Q5689100","display_name":"Head (geology)","level":2,"score":0.2671000063419342},{"id":"https://openalex.org/C2910979460","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic Procedures","level":3,"score":0.2531999945640564}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1186/s13018-026-07315-z","doi":"https://doi.org/10.1186/s13018-026-07315-z","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07315-z","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1186/s13018-026-07315-z","doi":"https://doi.org/10.1186/s13018-026-07315-z","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07315-z","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[{"display_name":"Systematic Review","id":"https://openalex.org/study-designs/systematic-review"},{"display_name":"Meta-Analysis","id":"https://openalex.org/study-designs/meta-analysis"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2288217676","https://openalex.org/W6889829075","https://openalex.org/W7168652903","https://openalex.org/W2304212658","https://openalex.org/W4408175437","https://openalex.org/W6927312600","https://openalex.org/W2340981001","https://openalex.org/W2311139813","https://openalex.org/W2465524093","https://openalex.org/W7099876119"],"abstract_inverted_index":{"Femoral":[0],"head":[1,12,55,335],"collapse":[2,41,182,336],"substantially":[3],"influences":[4],"the":[5,10,27,33,66,161,215,223,227,294,297,305,313,321,340],"management":[6],"of":[7,9,32,70,123,131,139,165,180,206,230,296,308,342,408],"osteonecrosis":[8],"femoral":[11,54,334],"(ONFH).":[13],"Magnetic":[14],"resonance":[15],"imaging":[16],"(MRI)":[17],"can":[18],"quantify":[19],"necrotic":[20,37,48,173,242,328],"lesion":[21],"extent":[22],"before":[23,125],"radiographic":[24],"collapse,":[25,126],"but":[26,214,339,368],"strength,":[28],"precision,":[29],"and":[30,39,74,93,108,127,137,157,221,275,317,323,347,352,360,405],"generalizability":[31],"association":[34,343],"between":[35],"MRI-derived":[36,47,85,327,355],"burden":[38,49,174,243,329],"subsequent":[40,53,181,333],"remain":[42],"uncertain.":[43],"We":[44],"systematically":[45],"evaluated":[46],"in":[50,61,337],"relation":[51],"to":[52,80,258,264,288],"collapse.":[56],"The":[57],"protocol":[58],"was":[59,133,175,218,310],"registered":[60],"PROSPERO":[62],"(CRD420261456638).":[63],"PubMed,":[64],"Embase,":[65],"Cochrane":[67],"Library/CENTRAL,":[68],"Web":[69],"Science,":[71],"CNKI,":[72],"Wanfang,":[73],"VIP":[75],"were":[76,87,152],"searched":[77],"from":[78],"inception":[79],"8":[81],"August":[82],"2026.":[83],"Quantitative":[84],"measures":[86,362],"synthesized":[88],"separately":[89],"as":[90,366],"lesion-burden,":[91],"necrotic-angle,":[92],"continuous":[94,228,324],"measurement":[95,350],"frameworks.":[96],"Random-effects":[97],"meta-analyses":[98],"used":[99],"restricted":[100,263],"maximum":[101],"likelihood":[102],"estimation":[103],"with":[104,177,332],"Knapp-Hartung-adjusted":[105],"confidence":[106],"intervals":[107,303],"95%":[109,185,191,247,253,283],"prediction":[110,192,216,254,284,302,389],"intervals.":[111],"Additional":[112],"sensitivity":[113,261],"analyses":[114,291],"examined":[115],"threshold":[116],"derivation,":[117],"minimum":[118],"follow-up":[119],"duration,":[120],"temporal":[121],"sequencing":[122],"MRI":[124,267,379,397],"individual-study":[128],"influence.":[129],"Risk":[130],"bias":[132],"assessed":[134],"using":[135,141,394],"QUIPS,":[136],"certainty":[138],"evidence":[140,309,373],"GRADE":[142],"for":[143,312,320],"prognostic-factor":[144],"evidence.":[145],"Eighteen":[146],"reports":[147],"representing":[148],"16":[149],"cohort":[150],"families":[151],"included":[153,269],"after":[154],"study-level":[155],"eligibility":[156],"extraction":[158],"re-audit.":[159],"In":[160,226],"primary":[162,314],"binary":[163,315],"analysis":[164,229,262,316],"six":[166,231],"studies":[167,196,232,271],"involving":[168,197,233,272],"383":[169],"hips,":[170,235],"higher":[171],"MRI-quantified":[172,241],"associated":[176,331],"greater":[178,240],"odds":[179],"(OR":[183],"31.62,":[184],"CI":[186,209,248,281],"11.70\u201385.50;":[187],"I\u00b2":[188,211,250],"=":[189,212,251],"23.8%;":[190],"interval":[193,217,255,285],"5.60-178.67).":[194],"Four":[195],"336":[198],"hips":[199,238,274,410],"evaluating":[200],"necrotic-angle":[201,322],"metrics":[202],"yielded":[203,276],"an":[204],"OR":[205],"52.55":[207],"(95%":[208,280],"6.33-436.25;":[210],"63.8%),":[213],"extremely":[219],"wide":[220],"crossed":[222,304],"null":[224],"(0.20\u201314,090.93).":[225],"359":[234],"subsequently":[236],"collapsed":[237],"had":[239],"(Hedges\u2019":[244],"g":[245,278],"2.23,":[246],"1.29\u20133.16;":[249],"86.0%;":[252],"\u2212":[256,286],"0.31":[257],"4.76).":[259],"A":[260],"unequivocally":[265],"pre-collapse":[266,396],"assessment":[268],"four":[270],"231":[273],"Hedges\u2019":[277],"1.83":[279],"0.51\u20133.14;":[282],"1.82":[287],"5.48).":[289],"Sensitivity":[290],"generally":[292],"preserved":[293],"direction":[295],"average":[298],"associations,":[299],"although":[300],"several":[301],"null.":[306],"Certainty":[307],"low":[311,319],"very":[318],"analyses.":[325],"Greater":[326],"is":[330,344,411],"ONFH,":[338],"magnitude":[341],"imprecisely":[345],"estimated":[346],"varies":[348],"across":[349],"approaches":[351],"study":[353],"settings.":[354],"volume,":[356],"area,":[357],"surface,":[358],"angular,":[359],"spatial":[361],"should":[363],"be":[364],"regarded":[365],"related":[367],"non-interchangeable":[369],"prognostic":[370],"markers.":[371],"Current":[372],"does":[374],"not":[375],"support":[376],"a":[377,381,386],"universal":[378],"threshold,":[380],"stand-alone":[382],"treatment":[383],"rule,":[384],"or":[385],"validated":[387],"individual-risk":[388],"model.":[390],"Prospective":[391],"multicenter":[392],"validation":[393],"clearly":[395],"assessment,":[398],"standardized":[399],"measurements,":[400],"predefined":[401],"thresholds,":[402],"adequate":[403],"follow-up,":[404],"appropriate":[406],"handling":[407],"bilateral":[409],"needed.":[412]},"counts_by_year":[],"updated_date":"2026-10-30T12:39:25.321706","created_date":"2026-10-28T00:00:00"}
