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Introduction: Non-traumatic osteonecrosis is a frequent complication in patients with autoimmune disorders, though its prevalence varies markedly depending upon the type of disorder. Understanding the causes of this difference can help uncover the underlying pathophysiology of osteonecrosis and guide the development of effective preventive and therapeutic strategies., Areas Covered: In this perspective study, we reviewed available databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to explore why the risk of osteonecrosis varies among different autoimmune disorders. Is this variation primarily due to the disease's pathophysiology, the use of medications such as corticosteroids, or a combination of both? If both factors are involved, what is the extent of each contribution in this context?, Expert Opinion: Non-traumatic osteonecrosis is often induced by an interaction between disease pathophysiology and corticosteroid use. In patients with different autoimmune disorders but an identical history of corticosteroid use, the risk of osteonecrosis is influenced by how the underlying pathophysiology compromises bone health. In autoimmune disorders with multiple adverse effects on bone, such as SLE (systemic lupus erythematosus), there is a much higher risk of osteonecrosis compared to disorders with minimal impact on bone health, such as celiac disease and MS (multiple sclerosis).

Background: Osteonecrosis of the femoral head can be a debilitating disease leading to collapse of the femoral head and the subsequent need for a hip arthroplasty. Core decompression has emerged as a leading treatment to prevent collapse. Adjunctive therapies, such as bone graft, bone marrow aspirate concentrates, or synthetic bone substitutes are utilized to promote native bone regeneration. Determining the amount of bone resected and the volume of adjunct required is challenging, especially with newer minimally invasive reamers. Under- or over-filling the defect may impact progression of the disease or cause morbidity., Surgical Technique: We introduce a mathematical method to be utilized intraoperatively to calculate the volume of bone resected during core decompression with an expandable reamer. This method approximates the core decompression defect as two cylinders using measurements that can be easily taken during the procedure and can be adapted for use with any of the expandable reamer systems available. Using this technique, surgeons can calculate the size of the defect created, which can be used to personalize the amount of adjunct delivered to each patient., Conclusions: When adjunctive therapies are used with core decompression to treat ONFH, care must be taken when filling the core decompression defect to avoid under- or over-filling the defect, potentially increasing the risk of complications or reducing the efficacy of the procedure. We provide a simple worksheet that can be used by surgeons to help determine how much adjunct should be used., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Appropriate consent has been obtained for any case details and patient imaging. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Steroids are used in management of coronavirus disease 2019 (COVID-19) patients with severe illness and their use has been demonstrated to decrease mortality. Although life-saving, steroids are well documented as risk factors for osteonecrosis. Osteonecrosis of the hip can be debilitating and surgery may be required to improve the quality of life. With the increasing number of COVID-19 cases, osteonecrosis of the hip and other joints resulting from steroid use is expected to show a sharp rise in the coming years. In this review we discuss the association between steroids and osteonecrosis, indications for steroid therapy in COVID-19 patients, and incidence, diagnosis, and treatment of osteonecrosis secondary to steroids in COVID-19.

Purpose: The aim of this systematic review and survival analysis was to quantify the benefits of orthobiologic augmentation therapies for the treatment of avascular necrosis (AVN) of the femoral head and identify the most effective approach to delay the need for total hip arthroplasty (THA)., Methods: A systematic review of the literature was performed on PubMed, Scopus, and Cochrane on clinical studies on orthobiologic therapies used alone or as an augmentation to core decompression or other procedures to address hip AVN. A qualitative analysis of the different biological therapies applied was performed. Afterward, the results of these procedures were quantitatively analysed to document their survivorship from THA compared to treatment groups without orthobiologics. Kaplan-Meier analysis was performed for all studies and then by categorising orthobiologics into treatment subgroups., Results: A total of 106 studies were included (4505 patients). Different orthobiologic approaches have been evaluated: cell-based therapies including bone marrow aspirate concentrate (BMAC) and bone marrow mesenchymal stromal cells (BM-MSCs), platelet-rich plasma (PRP), or other bioactive molecules applied in the osteonecrotic area or as intra-arterial injections. The survival analysis at 120 months documented a higher (p < 0.0005) cumulative survivorship with orthobiologics (69.4%) compared to controls (48.5%). The superiority was shown specifically for BMAC (p < 0.0005), BM-MSCs (p < 0.0005), intra-arterial (p < 0.0005) and PRP (p = 0.011) approaches, but the direct comparison of these approaches with their controls confirmed benefits only for BMAC (p < 0.0005)., Conclusion: This systematic review and survival analysis demonstrated that orthobiologics have the potential to improve survivorship in patients affected by hip AVN. In particular, the specific analysis of different orthobiologic products supported relevant benefits for BMAC augmentation in terms of survival from the need for THA, while no clear benefits were confirmed for other orthobiologics., Level of Evidence: Level III., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Osteonecrosis of the femoral head (ONFH) affects at least 20,000 patients annually in the United States; however, the pathophysiology of disease progression is poorly understood. The purpose of this study was to determine the relative importance of three distinct elements and their relationship to the collapse of the femoral head as follows: (1) identifiable risk factors, (2) femoral head anatomy, and (3) the extent of the necrotic lesion., Methods: A single-center retrospective cohort study was performed on patients ≥ 18 year old who presented with ONFH. Ficat classification and femoral head anatomic parameters were measured on radiographs. Osteonecrotic lesion size was measured on magnetic resonance imaging using four validated methods. Multivariable regression analyses were performed to identify predictors of femoral head collapse., Results: There were 105 patients and 137 hips included in the final cohort, of which 50 (36.5%) had collapse of the femoral head. Multivariable analyses demonstrated that medical risk factors (adjusted odds ratio (aOR): 1.15), alcohol exposure (aOR: 1.23), and increased alpha angle (aOR: 4.51) were predictive of femoral head collapse. Increased femoral head offset (aOR: 0.54) was protective against collapse. An increased size of the osteonecrotic lesion was significantly predictive of collapse with all four measurement methods evaluated: three-dimensional volumetric (aOR: 3.73), modified Kerboul (aOR: 2.92), index of necrotic extent (aOR: 1.91), and modified index of necrotic extent (aOR: 2.05)., Conclusions: In an analysis of patients who had ONFH, we identified risk factors such as alcohol exposure, high alpha angle, increased lesion size, and decreased femoral offset as increasing the risk of femoral head collapse. Given the challenges of studying this patient population, large prospective studies of patients who have ONFH should seek to identify whether these factors are reliable indicators of femoral head collapse., Level of Evidence: III., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study emphasizes the importance of early detection of osteonecrosis of the femoral head (ONFH) in young patients on long-term glucocorticoid therapy, including those with acute lymphoblastic leukemia, lupus, and other diagnoses. While X-ray and magnetic resonance imaging (MRI) are standard imaging methods for staging ONFH, MRI can be costly and time-consuming. The research focuses on utilizing artificial intelligence (AI) to enhance the evaluation of radiographic images for ONFH detection. The study involved analyzing X-ray and MRI from 102 control hips and 104 ONFH-affected hips at Association Research Circulation Osseous (ARCO) Stage II and IIIa. We employed transfer learning with the YOLOv8 model for object detection, using 80% of the data for training and 20% for validation, then assessed detection accuracy through mean average precision (mAP) and a precision-recall curve. Additionally, AI generated synthetic MRI (sMRI) from X-ray images using a Generative Adversarial Network (GAN) and evaluated their similarity to original MRI. Results showed that the mAP for ONFH detection was 0.923 for the YOLOv8n model and 0.951 for YOLOv8x. The GAN-generated sMRI exhibited lower image quality compared with originals but maintained potential for lesion assessment. Intrarater reliability among evaluators was high. The findings indicate that AI techniques, particularly YOLOv8 for object detection and GAN for image generation, can effectively assist in ONFH screening, despite some limitations in the generated MRI quality., (© 2024 Orthopaedic Research Society.)

Introduction: Sesamoid bones absorb and disperse weight from the metatarsal bones. Sesamoid injuries occur primarily in dancers and runners, with nonoperative management as the first line of treatment. Due to the lack of secondary blood supply, the sesamoids are at risk for osteonecrosis and nonunion fractures. The literature supporting orthobiologics for the treatment of sesamoid injuries is limited. Methods: In this case, a 28-year-old female dancer with sesamoid osteonecrosis underwent a leukocyte-rich platelet-rich plasma (LR-PRP) injection to the fibular sesamoid. Results: The patient reported significant improvement in pain at the 2-month follow-up and returned to regular auditions at the 3-month follow-up. At 2-year follow-up, the patient's symptoms returned to baseline. Conclusion: This is the first known case of sesamoid osteonecrosis treated with LR-PRP. LR-PRP should be considered in the treatment of sesamoid osteonecrosis in those who show limited improvement with standard conservative measures., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Osteonecrosis (ON) is a debilitating orthopedic condition characterized by bone cell death due to impaired blood supply, leading to structural changes and disability. Osteoporosis (OP), a systemic skeletal disease, results in reduced bone density and quality, making bones fragile and prone to fractures. Although distinct, OP and ON share several risk factors such as corticosteroid use and smoking. This study aims to investigate the causal relationships between OP, bone mineral density (BMD), and ON using a bidirectional two-sample Mendelian randomization (MR) approach., Methods: This study utilized genome-wide association study (GWAS) data for OP from the FinnGen database, and BMD data for the lumbar spine and femoral neck from the Genetic Factors for Osteoporosis (GEFOS) consortium. ON data were also obtained from the FinnGen database. All participants were of European descent. Genetic instruments were selected based on genome-wide significance, linkage disequilibrium, and strength (F-statistic). Bidirectional MR analysis was performed using inverse-variance weighted (IVW), MR-Egger regression, and weighted median methods to assess causality. Sensitivity analyses, including Cochran's Q test and MR-PRESSO, were conducted to evaluate heterogeneity and pleiotropy., Results: MR analysis demonstrated a positive causal effect of OP on ON using the IVW method, with an odds ratio (OR) of 1.223 (95% CI: 1.026-1.459, P = 0.025). The weighted median method also confirmed this result with an OR (95% CI) 1.290 (1.021-1.630), P = 0.033. No significant causal effects were found between BMD (lumbar spine and femoral neck) and ON. Furthermore, ON did not exhibit a causal effect on OP or BMD. Sensitivity analyses confirmed the robustness of the results, showing no evidence of heterogeneity or pleiotropy., Conclusion: This study provides evidence of a unidirectional causal relationship between OP and ON, suggesting that individuals with a genetic predisposition to OP have an increased risk of developing ON. These findings highlight the importance of early OP detection and management to potentially reduce ON incidence. The lack of a significant causal relationship between BMD and ON indicates that factors other than bone density, such as vascular health, may play a crucial role in ON development. Future research should explore these mechanisms further to inform clinical interventions., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Introduction: Osteonecrosis usually occurs with necrotic bone exposure in the mandible asymptomatically for long periods but can evolve to present pain, fistula, odor, bleeding, and suppuration., Objective: To evaluate the influence of cyclosporine treatment and its influence on osteonecrosis in a rat model., Methods: The animals were randomly divided into 05 groups (n = 8/group). The negative control group (SAL), positive control group treated with zoledronic acid (ZA + SAL), and test groups were treated with cyclosporine A (CsA) at 5, 2.5, and 1.25 mg/kg and treated with ZA. The left lower second molars were extracted. The animals were euthanized 1 month after tooth extraction. Digital radiographs, histological slides, and immunoexpression of IL-2, IL-6, TNF-α, PPAR-γ, c-Fos, c-Jun, FoxP3, and INF-γ were analyzed. Western blot assays were performed to investigate the expression of RORyT. In addition, hematological analysis, body mass variation, and femur mechanical tests were performed., Results: Radiographs showed that in the groups treated with ZA, there was an increase in the radiolucent area suggestive of osteonecrosis, and treatment with cyclosporine did not reduce this parameter (p < 0.001). In the western blot analysis, animals treated with ZA showed increased expression of RORyT (1.887 ± 0.114) compared to the saline group (0.799 ± 0.107), and treatment with the highest dose of cyclosporine (0.652 ± 0.070) reduced this expression (p < 0.001)., Discussion: Studies have observed bone health in animals treated with CsA. Treatment with this immunosuppressant showed a bone-protective effect of CsA, which corroborates our findings., Conclusion: Treatment with CsA reduced the immunoexpression of pro-inflammatory cytokines such as IL-2 and TNF-α and decreased the expression of RORyT., Competing Interests: Declarations. Conflict of interest: There are no conflict of interest., (© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), characterized by persistent jaw bone exposure, is believed to result from the inhibition of bone remodeling and wound healing, often associated with potent intravenous bisphosphonates such as zoledronic acid (ZA). These bisphosphonates are known to significantly impact the healing of soft and bone tissues due to their anti-angiogenic properties. Our study aimed to explore whether applying the basic fibroblast growth factor (bFGF), known for its ability to promote angiogenesis and bone remodeling, over extraction sockets could prevent the onset of BRONJ in rats administered with ZA. The experimental protocol involved administering each rat with two intravenous injections of 60 μg/kg of ZA, followed by tooth extraction. Rats were then divided into two groups: the test group (n = 12), which had a mixture of 3% hydroxypropyl cellulose (HPC) and 0.3% bFGF applied over their extraction sockets, and the control group (n = 12), which received only a 3% HPC application. Wound healing was monitored for 8 weeks post-extraction and assessed using micro-computed tomography, histological evaluations, and immunohistochemical analysis of CD31- and CD105-positive vessels. Results showed a BRONJ incidence rate of 100% (12/12) in the control group, whereas the rate was significantly lower in the test group at 8.3% (1/12). Furthermore, the test group demonstrated marked increases in both angiogenesis and new bone formation. Our findings suggest that the local application of bFGF might serve as an effective therapeutic approach to prevent the onset of BRONJ following tooth extraction in patients receiving bisphosphonate therapy., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article. Ethics approval: This animal study was approved by the animal care and use committee of Nara Medical University (Permit Number: 12997). Consent: Not applicable., (© 2025. The Author(s).)

This case highlights the importance of taking Systemic Lupus Erythematosus seriously and its possible concurrent musculoskeletal complications, as they can have significant health implications. Consulting and encouraging patients to adhere to the treatment is crucial. Although this case survived osteomyelitis without amputation, this outcome is rare and cannot be generalized., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Understanding the intraosseous vascularity of the femoral head is important for preserving its structural integrity and function. Disruptions in microcirculation can lead to osteonecrosis of the femoral head (ONFH). This anatomical study aimed to quantify the regional distribution of the microvessels within the trabecular bone of the femoral head., Methods: Eleven beagles (five males, six females) were infused with intra-aortic radiopaque silicon, followed by micro-computed tomography imaging and 3D modelling using Avizo. EXAKT non-decalcified plastinated tissue histology of the proximal femur was performed and quantified using the Bioquant Osteo semi-automated histomorphometry with ImageJ. Vascular diameter, density, length density, and osteochondral parameters were calculated and compared within the subcortical and central zones of the femoral head in both sexes., Results: A well-developed intraosseous microvascular network was identified within the trabecular struts, resembling Volkmann's canals and integrating into Haversian system at the subchondral compact bone. Dense capillary networks traversed both trabecular and cortical bone to supply articular cartilage. Subcortical microvasculature was denser, with thinner diameters and shorter lengths compared to the central zone. The middle part of the femoral head displayed higher subcortical vascular density compared to superior and inferior parts. Strong positive correlations were observed between the endocortical area, tissue area, mean cortical width, bone surface and trabecular spacing. A moderate negative correlation was found between quiescent surface and cartilage density. No significant sex differences were observed in vascularity or bone metrics., Conclusion: Based on the spatial distribution of the microvasculature, the central zone serves as a conduit for primary intraosseous blood vessels, supplying the subcortical zone, including the cortex and articular cartilage. These findings establish baseline reference values for normal intraosseous microvessels and bone metrics in canine anatomy, which can be utilized for diagnosing and treating osteochondral diseases., Competing Interests: Declarations. Ethical approval: This study was approved by the Biomedical Ethics Committee of Dalian Medical University (Ethics number: 2023-004). All fresh cadaver beagles were provided by surgical practice skills lab of the university. Experiments were carried out in accordance with guidance on the operation of the animals, Dalian Medical University, China. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background/Objectives : The oral cavity has garnered increasing attention as a site for viral infection and related pathological manifestations in coronavirus disease-19. This article aims to provide a comprehensive overview of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)-related oral manifestations, including taste disturbances, oral lesions and osteonecrosis. Methods : A search was conducted up to September 2024 according to PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines using the databases PubMed and Scopus. All the observational, case-series, case-report and cross-sectional studies written in English on oral manifestations related to COVID-19 disease and long-COVID disease were included. All other types of studies and studies based on oral manifestation after COVID-19 vaccination and oral impairment due to lockdown were excluded. The risk of bias of included studies was assessed using the Joanna Briggs Appraisal checklist. Results : A total of 104 articles including 23 case-report, 15 case-series, 8 case-control, 18 cohort and 40 cross-sectional studies were selected. The results showed that patients with COVID-19 were found to have a significantly higher prevalence of xerostomia (45-74%) and dysgeusia (32-59%) compared to non-infected individuals. Regarding oral mucosal lesions, ulcers, candidiasis and herpes simplex infections were frequently observed. As for osteonecrosis, a significant number of patients with COVID-19-associated rhinomaxillary mucormycosis presented with maxillary osteonecrosis due to fungal infection, primarily mucormycosis. The methodological quality of most of the studies was moderate/high. Conclusions : COVID-19 has been associated with a range of oral manifestations. The complex interplay of viral infection, immune response, medication use and stress likely contributes to these oral complications. Early recognition and management of these oral manifestations are crucial for improving patient outcomes and developing targeted preventive and therapeutic strategies for COVID-19-related oral health issues.

Background: While anatomic total shoulder arthroplasty (aTSA) is standard of care in older patients with an intact rotator cuff undergoing shoulder arthroplasty for osteoarthritis (OA), rheumatoid arthritis (RA), late post-traumatic sequelae (LPTS) or avascular necrosis (AVN), superiority of aTSA versus shoulder hemiarthroplasty (HA) remains controversial in younger patients. This study aimed to compare these two procedures in patients under 60 years regarding 1) overall and diagnosis specific revision rates, and 2) overall one-year change in pain and function., Methods: A retrospective cohort study was performed with data from the Dutch Arthroplasty Register (LROI) from 2014-2022. All patients with OA, RA, LPTS or AVN under 60 years undergoing HA or aTSA were included. Cox proportional hazards regression analysis was performed to compare the incidence of revision in these nine years, adjusting for diagnosis, Walch classification and year of surgery. Also, the one-year postoperative change on the numeric rating scale for pain during activity (NRS, range 0-10) and the Oxford Shoulder Score (OSS, range 0-48) were compared between these two procedures using multivariate linear regression analysis. Multiple testing was adjusted for as proposed by Benjamini and Hochberg., Results: In total, 521 HAs and 1056 aTSAs were included (median age 54.0 years, 73.6% OA, 4.4% RA, 12.0% LPTS and 10.0% AVN). The overall unadjusted 8-year revision rates were 21.1% (95% CI 16.9-26.4%) and 11.3% (95% CI 8.8-14.5%) in the HA and aTSA group, respectively. In the total study population, HAs had a 1.77 (95% CI 1.24-2.53) times higher hazard on revision after adjustment for potential confounders. In the subgroup of OA or RA, the hazard ratio was 2.21 (95% CI 1.47-3.34) in favor of aTSA, and in the subgroup of LPTS or AVN, this ratio was 1.13 (95% CI 0.59-2.18). In the whole study population, 16.5% of patients provided PROM data, and while there was no statistically significant difference for the adjusted one-year change on the NRS between the groups, the OSS showed a 5.0 (95% CI 0.5-9.5) points greater improvement in the aTSA group., Conclusion: In younger patients with an intact rotator cuff, aTSA is superior to HA regarding medium-term revision rates when performed for OA or RA, whereas revision rates are comparable in case of LPTS or AVN. Also, while the survey response rate was limited, overall patient-reported shoulder function may undergo a relatively greater one-year improvement after aTSA than after HA., (Copyright © 2025. Published by Elsevier Inc.)

Objectives: To determine the impact of alveolar socket surface area and number of root extractions for developing medication-related osteonecrosis of the jaw (MRONJ) in polypharmacy patients following multiple tooth extractions., Materials and Methods: A retrospective sample of 40 patients was recruited, including 20 polypharmacy patients (109 tooth extractions) who developed MRONJ in at least one of the extraction sites, matched with 20 controls (100 tooth extractions). Tooth-specific alveolar socket surface areas were assessed using CBCT scans from the control group to establish reference values for alveolar socket surface areas in polypharmacy patients with MRONJ. Correlations between the number of extracted tooth roots, alveolar socket surface area, and development of MRONJ were analysed within the polypharmacy group., Results: 40% of tooth extractions in polypharmacy patients undergoing multiple extractions resulted in the development of MRONJ, with a higher prevalence observed in the mandible (44%). Among the extracted mandibular tooth roots, half were susceptible to MRONJ, and 45% of the exposed socket surface area was affected. Both jaws showed an increased risk (20%) of MRONJ following molar extraction. A strong positive correlation existed between extraction sites that developed MRONJ and both the number of mandibular tooth roots extracted (r = + 0.861; p < 0.001) and the total exposed alveolar socket surface area (r = + 0.757; p < 0.001). However, no significant correlations were observed in the upper jaw., Conclusions: This study is the first to demonstrate that both mandibular alveolar socket surface area and number of extracted tooth roots are positively related to extraction sites developing MRONJ in polypharmacy patients undergoing multiple tooth extractions., Clinical Relevance: Identifying high-risk patients and implementing preventive strategies can reduce MRONJ incidence, underscoring the need for careful management of polypharmacy patients, especially those undergoing mandibular tooth extractions., Competing Interests: Declarations. Ethical approval: Ethical approval was obtained from the Ethical Review Board of the University Hospitals Leuven (reference number: S57824). Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Among the various musculoskeletal manifestations of post-acute Coronavirus disease 2019 (COVID-19) syndrome, osteonecrosis and pyogenic infections are of serious concern due to their potential for joint destruction and the need for major surgery, even among young patients. Spontaneous septic arthritis is rare among healthy adults. Very few cases of osteonecrosis of the femoral heads (ONFH) with concomitant septic arthritis of the hip following a COVID-19 infection are reported in the literature., Case Report: We report the case of a 43-year-old male patient, who presented with bilateral ONFHs and concomitant septic arthritis of the hips (caused by Pseudomonas aeruginosa), 8 weeks following a severe COVID-19 infection. His serum inflammatory markers were elevated. Radiologic findings were equivocal, and suggestive of osteonecrosis, with possible septic arthritis of the hip. In view of disabling end-stage arthritis, he was advised bilateral total hip arthroplasty (THA), in one or two stages, depending on the intraoperative findings. The diagnosis of infection was confirmed through intraoperative frozen section analysis. Bilateral two-staged THA was performed. At 3 years' follow-up, the patient had no recurrence of symptoms, and was found to be doing well, with a Harris Hip Score of 93 points, and no limb length discrepancy., Conclusion: COVID-19 infection predisposes patients to the development of ONFH. Concomitant septic arthritis of the hip, however, is scarcely reported, and needs to be ruled out in cases with rapid progression of symptoms., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Objective: Although some patients may experience collapse progression while others may not in post-collapse osteonecrosis of the femoral head (ONFH) with a necrotic lesion located within the weight-bearing part of the acetabulum (Type B/C1), few studies have focused on the natural course after collapse. This study aimed to clarify the correlation between necrotic volume (NV) and necrotic depth (ND) in predicting collapse progression in patients with post-collapse ONFH Type B/C1., Materials and Methods: We retrospectively reviewed 54 hips with post-collapse ONFH Type B/C1 from 52 consecutive patients who were conservatively followed up for more than 1 year. We measured the amount of femoral head collapse using biplane radiographs at each follow-up period, and produced Kaplan-Meier survival curves with collapse progression (≥ 1 mm) as the endpoint. We compared NV and ND, which were calculated as the ratio of the distance from the articular surface of the femoral head to the deepest point of a necrotic lesion to the femoral head diameter in the mid-coronal slice of T1-weighted magnetic resonance imaging (MRI)., Results: We observed collapse progression in 31 hips (57.4%). The NV and ND were significantly greater in hips with collapse progression than in those without collapse progression (p = 0.0127 and 0.0047, respectively). Necrotic volume was significantly correlated with ND　(rs = 0.56, p < 0.0001)., Conclusion: This study suggests that necrotic depth on the mid-coronal slice of T1-weighted MRI can be a substitute for necrotic volume to predict collapse progression in ONFH Type B/C1., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Introduction: This study aimed to analyze the factors affecting the occurrence of peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ) in patients using anti-resorptive drugs (ARDs) on different implant position, inclinations, and types of prosthesis., Methods: The data of 75 patients with bone necrosis that progressed around the implant between 2018 and 2022 were retrospectively examined to identify the factors influencing PI-MRONJ. Data, including patient demographics (age, sex, smoking status, concomitant disease, time of ARD therapy, dose of ARDs, and parafunctional habits) and implant-specific information (type of prosthesis, angle of insertion), were extracted from medical and dental records., Results: Tilted implants with an angle ≥ 5.1° relative to the occlusal plane of the prosthesis had a stronger association with PI-MRONJ in comparison to non-tilted implants (inclination was < 5°). Additionally, the boundary of the area of osteonecrosis around the fixture was larger for the splinted implant-supported crowns than for the single implant supported crowns)., Conclusion: In patients taking anti-resorptive medications the inclination of the implant was associated with the occurrence of PI-MRONJ. Further studies are required to confirm the clinical findings., (© 2024 The Author(s). Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Medication-related osteonecrosis of the jaw (MRONJ) is an infectious side effect associated with bisphosphonates and monoclonal antibodies (denosumab, immune modulators, and antiangiogenic medications). Adjunctive therapies for the surgical management of MRONJ include autologous platelet concentrates (APCs). These APCs serve as a source of various cells and growth factors that aid tissue healing and regeneration. This review evaluated the use of platelet-rich plasma (PRP), plasma-rich in growth factors (PRGF), and leukocyte- and platelet-rich fibrin (L-PRF) as adjuvant therapies for the surgical management of MRONJ by conducting analyses on the results of 58 articles. Compared to surgical treatment alone, the application of PRP and L-PRF after surgery appears to increase healing in the management of patients with MRONJ. No studies have reported unhealed lesions as a result of surgical treatment of MRONJ with PRGF application or compared it with surgical treatment alone. The overall results of this review have shown favorable healing rates of MRONJ lesions managed with the application of APCs after surgical treatment; however, significant methodological limitations may limit the scientific evidence supporting their use. Further randomized controlled trials with strict criteria are needed to establish the extent to which APCs can improve wound healing and quality of life in patients with MRONJ requiring surgical treatment., (© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.)

Introduction and Importance: Intraosseous anesthesia (IOA), an important technique in dental anesthesia, delivers anesthetic directly into the bone, enhancing patient comfort and minimizing side effects. Despite advantages, several disadvantages are known such as injection discomfort, root damage, mechanical obstructions and needle fractures. This report highlights a rare yet significant complication of focal mandibular osteonecrosis following IOA., Case Presentation: A 35-year-old male was referred with interdental septum necrosis between teeth 46 and 47, four months post-IOA. CBCT scan confirmed the septum sequestration and periapical osteolysis extending into the mandibular canal. The patient underwent sequestrectomy and tooth extraction under local anesthesia, successfully relieving him of pain., Clinical Discussion: Focal osteonecrosis of the jawbone is possibly caused by factors such as frictional heat, improper pressure during perforation, absence of water cooling, and the use of vasoconstrictor-containing anesthetics, impairing blood flow in the low vascularized bone of the interdental septum. Most osteonecrosis cases so far reported are linked to medication, immunocompromised status or irradiation., Conclusion: Focal mandibular osteonecrosis is a rare complication of intraosseous anesthesia. To our knowledge, this is the first reported case of focal osteonecrosis in the mandible in a healthy patient. There are no previous reports in the literature to show this complication in an otherwise healthy individual., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The treatment of Kümmell disease (KD) is controversial. Corpectomy and reconstruction or osteotomy with long-level fusion was traditionally performed for the advanced KD. However, these procedures can be disadvantageous for elderly patients. Several alternative surgical procedures including transpedicular intravertebral cage augmentation (TPICA) or vertebroplasty (VP) combined with short-segment fixation (SSF) have been suggested to minimize the surgical burden. This study aimed to compare the outcomes of percutaneous TPICA plus SSF with VP plus SSF for advanced thoracolumbar (T11-L2) KD and to introduce our novel percutaneous TPICA technique using specially designed cannulated cage trials., Methods: We devised specially designed cannulated cage trials to make the TPICA procedure safer and more reproducible, minimizing the risk of the pedicle medial wall violation. All consecutive patients who underwent percutaneous TPICA or VP combined with SSF for advanced thoracolumbar KD, from January 2021 to June 2022, with ≥ 1-year follow-up at a single institution, were included. Perioperative details, clinical outcomes (visual analog scale and Oswestry Disability Index), and radiological outcomes (anterior vertebral body compression percentage and vertebral kyphotic angle [VKA] of the fractured vertebra, and local Cobb angle [LCA]) were collected and compared between the groups., Results: A total of 42 patients were enrolled, with 21 patients in each group. There were no patients with pedicle medial wall fracture in the TPICA group. Both procedures provided significantly favorable radiological outcomes compared to those preoperatively. No significant differences were observed in the changes over time in all radiological parameters between the groups. Loss of correction during the follow-up period was significantly smaller in patients with TPICA than in those with VP in VKA (median [interquartile range], 2.15 [0.30-2.80] vs. 2.90 [0.90-6.53]; p = 0.030) and LCA (2.70 ± 2.90 vs. 5.17 ± 4.40, p = 0.037)., Conclusions: Both procedures are minimally invasive and useful options for advanced KD, especially for elderly patients with high comorbidity. Our novel percutaneous TPICA technique using cannulated cage trials, being safer and more reproducible, may allow spine surgeons to easily perform TPICA., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2025 by The Korean Orthopaedic Association.)

For this study, the surgical outcomes of patients with advanced medication-related osteonecrosis of the jaw (MRONJ), treated with different local flaps for soft-tissue closure, were evaluated. Cases of stage 2 and 3 MRONJ patients (n = 96) with a 12-month minimum follow-up were retrospectively analyzed. All patients underwent surgical treatment and soft-tissue closure with local flaps, including buccal fat flap (BFF), nasolabial flap (NLF), facial artery musculomucosal flap (FAMM-F), and submental island flap (SIF), based on the size and location of the defects. The occurrence of side effects was also evaluated. At the time of the last follow-up, 97.7% (42 of 43) of the patients in the BFF group, 90.3% (28 of 31) of the NLF patients, 100% (8 of 8) of the FAMM-F patients, and 92.9% (13 of 14) of the SIF patients showed mucosal integrity. No serious complications were observed. Five cases with relapsed MRONJ were in cancer patients who continued both chemotherapy and antiresorptive therapy. Different local flaps for soft-tissue closure after bone surgery in advanced MRONJ patients could provide a mechanically stable and well-vascularized covering of the exposed bone, leading to good healing., Competing Interests: Conflicts of interest All authors declare that they have no conflicts of interest., (Copyright © 2025 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Distinguishing between Osteonecrosis of the femoral head (ONFH) and Osteoarthritis (OA) can be subjective and vary between users with different backgrounds and expertise. This study aimed to construct and evaluate several Radiomics-based machine learning models using MRI to differentiate between those two disorders and compare their efficacies to those of medical experts., Methods: 140 MRI scans were retrospectively collected from the electronic medical records. They were split into training and testing sets in a 7:3 ratio. Handcrafted radiomics features were harvested following the careful manual segmentation of the regions of interest (ROI). After thoroughly selecting these features, various machine learning models have been constructed. The evaluation was carried out using receiver operating characteristic (ROC) curves. Then NaiveBayes (NB) was selected to establish our final Radiomics-model as it performed the best. Three users with different expertise and backgrounds diagnosed and labeled the dataset into either OA or ONFH. Their results have been compared to our Radiomics-model., Results: The amount of handcrafted radiomics features was 1197 before processing; after the final selection, only 12 key features were retained and used. User 1 had an AUC of 0.632 (95% CI 0.4801-0.7843), User 2 recorded an AUC of 0.565 (95% CI 0.4102-0.7196); while User 3 was on top with an AUC of 0.880 (95% CI 0.7753-0.9843). On the other hand, the Radiomics model attained an AUC of 0.971 (95% CI 0.9298-1.0000); showing greater efficacy than all other users. It also demonstrated a sensitivity of 0.937 and a specificity of 0.885. DCA (Decision Curve Analysis displayed that the radiomics-model had a greater clinical benefit in differentiating OA and ONFH., Conclusion: We have successfully constructed and evaluated an interpretable radiomics-based machine learning model that could distinguish between OA and ONFH. This method has the ability to aid both junior and senior medical professionals to precisely diagnose and take prompt treatment measures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Alkhatatbeh, Alkhatatbeh, Guo, Chen, Song, Qin and Wei.)

This study examines the biocompatibility, osteogenic potential, and effectiveness of polyether ether ketone (PEEK) composites for treating osteonecrosis, seeking to establish a theoretical basis for clinical application. A range of PEEK composite materials, including sulfonated polyether ether ketone (SPEEK), polydopamine-sulfonated polyether ether ketone (SPEEK-PDA), bone-forming peptide-poly-dopamine-sulfonated polyether ether ketone (SPEEK-PDA-BFP), and vascular endothelial growth factor-poly-dopamine-sulfonated polyether ether ketone (SPEEK-PDA-VEGF), were constructed by concentrated sulfuric acid sulfonation, polydopamine modification and grafting of bioactive factors. The experiments involved adult male New Zealand rabbits aged 24-28 weeks and weighing 2.6-4 kg. The SPEEK-PDA-BFP possesses the smallest water contact angle, indicating the highest hydrophilicity, with its surface characterized by a rich density of clustered BFP particles. The SPEEK-PDA-BFP exhibits superior adhesion, proliferation, and differentiation capabilities, along with pronounced bacteriostatic effects, which are attributed to its dense particle clusters. The SPEEK-PDA-BFP facilitates the formation of regular and dense bone trabeculae. Comparative study on treating osteonecrosis with SPEEK-PDA-VEGF and SPEEK-PDA-BFP highlighted the superior formation of mature bone trabeculae and angiogenic protein CD31 around SPEEK-PDA-VEGF. The PEEK composite materials have good biocompatibility, osteogenic activity and bone repair activity. In particular, SPEEK-PDA-VEGF composite materials have the best effect on bone repair., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This study assessed the nationwide incidence of Kienböck's Disease, and operations performed for Kienböck's Disease from the Care Register for Health Care in Finland 1996-2022. The mean annual total standardized incidence rate per million person-years was 9.60 (95% CI: 9.10-10.11) and for men and women, 10.38 (95% CI: 9.63-11.13) and 8.78 (95% CI: 8.10-9.45), respectively. The incidence rate was highest for 50-59-year-olds, at 15.49. Compared with women, the incidence rate for men was higher across all age groups up to 60-69 years. Altogether, 44% of the patients were operated on, and 19% of them had multiple operations. Partial arthrodesis was the most performed procedure and salvage procedures covered 62% of all operations. Our findings provide comprehensive new evidence about Kienböck's Disease distribution across Finland's population and offer insights into the burden caused by operations. Level of evidence: III.

Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic disorder characterized primarily by compromised blood supply. This vascular deficit results in cell apoptosis, trabecular bone loss, and structural collapse of the femoral head at late stage, significantly impairing joint function. While MRI is a highly effective tool for diagnosing ONFH in its early stages, challenges remain due to the limited availability and high cost of MRI, as well as the absence of routine MRI screening in asymptomatic patients. . In addition, current therapeutic strategies predominantly only relieve symptoms while disease-modifying ONFH drugs are still under investigation/development. Considering that blood supply of the femoral head plays a key role in the pathology of ONFH, angiogenic therapies have been put forward as promising treatment options. Emerging bioengineering interventions targeting angiogenesis hold promising potential for ONFH treatment. In this review, we introduce the advances in research into the pathology of ONFH and summarize novel bioengineering interventions targeting angiogenesis. This review sheds light upon new directions for future research into ONFH., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2025.)

Background: Avascular necrosis (AVN) of the femoral head is a degenerative condition characterized by ischemic bone death, resulting in pain and impaired mobility. Core decompression, a surgical intervention, is widely performed for stage II AVN to alleviate symptoms and delay disease progression. While clinical and radiological outcomes are well-documented, the psychosocial dimensions of recovery remain underexplored. This study aims to understand the experiences of physically active patients diagnosed with stage II AVN who have undergone core decompression surgery during their follow-up period, allowing for a broader evaluation of the experiences of this patient group., Methods: This study used semi-structured interviews, in-depth follow-up questions, and thematic analysis to explore the experiences of physically active patients who underwent core decompression surgery for stage II AVN of the femoral head. The participants were assessed 1-3 years post-surgery. Conducted in the Orthopaedics and Traumatology outpatient clinic of Adana City Training and Research Hospital, the study included 31 patients who had core decompression surgery between January 2020 and January 2024, with at least one year of follow-up data. Data collection, including demographic and qualitative information, was carried out during the first week of April 2024, followed by the member-checking process in the third week. A thematic analysis checklist and COREQ guidelines were used to ensure analysis reliability., Results: The experiences of 31 patients (mean age 37.19 ± 8.21 years, 12 females, 19 males) were summarized into five main themes that emerged from the data analysis process: 'Expectations and Concerns Before Surgery,' 'Postoperative Physical Experiences,' 'The Psychological and Emotional Process,' 'Social Support and Family Relationships,' and 'Health Services and Medical Support.'' Twelve sub-themes emerged from the main themes., Conclusions: Core decompression offers significant benefits to patients with stage II AVN by improving mobility and reducing pain. However, psychological support, patient education, and robust social networks are essential to address the holistic needs of recovery. These findings highlight the importance of integrating patient-centered approaches into surgical care to optimize outcomes and satisfaction. Further qualitative research is needed to explore the experiences of AVN patients at different stages to inform multidisciplinary care strategies., Competing Interests: Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Ethical approval: Ethical approval for the study was obtained from the Adana City Training and Research Hospital Clinical Research Ethics Committee on February 15, 2024, with meeting number 146 and decision number 3164. The patients’ rights, as outlined in the Declaration of Helsinki, were strictly observed. Participants received written information about the study’s purpose and procedures, and detailed verbal explanations were provided before each interview. They were fully informed of their rights and assured that they could withdraw from the study at any time. All participants signed informed consent forms in adherence to the principles of the Declaration of Helsinki regarding patients’ rights., (© 2025. The Author(s).)

Introduction: The humeral head is the second most common site for osteonecrosis but its epidemiology is poorly described. This study aimed to better understand its treatment in the United States by 1) evaluating total operative procedures with rates normalized to the annual surgical volume; 2) determining trends of non-joint preserving (shoulder arthroplasty) vs. joint preserving procedures; and 3) quantifying rates of operative techniques in different aged cohorts (<50 vs. ≥50 years old)., Methods: A nationwide database was queried for patients with humeral osteonecrosis who underwent surgery between January 1st, 2010 and April 30, 2021, yielding 9,307 cases. Patients classified under non-joint preserving procedures included those who underwent shoulder arthroplasty (total and reverse) (N = 5,752) and hemiarthroplasty (N = 2,086). Joint preserving procedures included humeral head core decompression and arthroscopic débridement (N = 1,469). The percentage of patients annually managed by each operative procedure was calculated and normalized to the overall annual surgical population from our sample. Linear regression modelling was performed to evaluate trends/differences in procedural volume over time based on the type of procedure (joint preserving vs. non-preserving) and age cohort (under versus over 50 years old). P-values < 0.05 were significant., Results: Within this nationwide sample, the number of procedures to treat shoulder osteonecrosis relative to all shoulder procedures was 0.85% (9,307/1,092,726). Overall, shoulder arthroplasty (total and reverse) was the most commonly performed procedure (N = 5,752; 61.8%), followed by hemiarthroplasty (N = 2,086; 22.4%), and core decompression/arthroscopic débridement (N = 1,469; 15.8%). Non-joint preserving comprised 7,838 procedures (84.2%), while 1,469 (15.8%) were joint preserving. On age group subanalysis, there were significantly more joint preserving procedures in patients aged <50 years (25.8% vs. 14.1%, P < 0.001). Core decompression/arthroscopic débridement as a proportion of all procedures in patients younger than 50 increased over the study period (22.1% to 35.6%, P = 0.035)., Conclusion: Procedures used to manage humeral osteonecrosis comprise less than 1% of all shoulder surgeries. These procedures continue to be predominantly shoulder arthroplasty; however, the utilization of joint preserving procedures seem to be growing over time, notably in patients <50 years of age. Shoulder surgeons may use this data to better educate patients about treatment options during the decision-making process. Future studies should be aimed towards further characterizing patterns in the diagnosis and treatment of humeral osteonecrosis., (Copyright © 2025. Published by Elsevier Inc.)

Objective: The focus of this study was to assess the diagnostic effectiveness of 99m Tc-MDP single-photon emission computed tomography/computed tomography (SPECT/CT) in pinpointing medication-related osteonecrosis of the jaw (MRONJ)., Methods: We gathered a total of 39 patients who were suspected of having MRONJ and displayed radionuclide concentration in the jaws on whole-body bone scans. These patients were subjected to simultaneous SPECT/CT fusion imaging of the jaws during delayed imaging. A consistent team of nuclear medicine physicians and oral and maxillofacial surgeons carried out diagnostic evaluations using SPECT/CT image analysis and dental specialist examinations, and the diagnoses were documented., Results: Based on the SPECT/CT image analysis and dental specialist examination outcomes, we calculated the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99m Tc-MDP SPECT/CT in diagnosing suspected MRONJ. Further, we enumerated the number and proportion of patients at each stage., Conclusion: Our findings suggest that 99m Tc-MDP SPECT/CT demonstrates high diagnostic precision in patients suspected of MRONJ who display radionuclide concentration in the jaw on whole-body bone scans. Moreover, it proves beneficial in identifying the early stages of MRONJ., Competing Interests: Declaration of competing interest All authors have no conflict of interest., (Copyright © 2025 Elsevier Masson SAS. All rights reserved.)

Background/Objectives : Defects in maxillary and mandibular continuity are common in maxillofacial practice. They can occur after trauma, osteonecrosis, congenital jaw deformities, or surgical resection of benign or malignant tumours. Reconstruction with microvascular bone flaps and subsequent prosthetic rehabilitation is considered the contemporary first line treatment. This study assessed the extent to which the underlying disease influences the treatment course of microvascular segmental jaw reconstruction. Methods : A retrospective review of prospectively collected data from all patients who underwent microvascular segmental jaw reconstruction from January 2011 to December 2020 was completed. The course of treatment as well as the process of dental rehabilitation was assessed. Results : Two hundred patients were included in the study. A total of 15.5% of patients were fitted with a conventional removable prosthesis, and implant-supported prosthetic restoration could be realized in 53.5% of patients. However, dental rehabilitation was not possible in 31.0% of patients. The outcomes of prosthetic restoration showed a statistically significant difference between the different underlying diseases ( p < 0.0001). About 50% of patients with malignant diseases and osteonecrosis remained without dental rehabilitation. In contrast, more than 90% of patients with jaw continuity defects, due to benign diseases or malformations, were able to receive an implant-supported prosthesis. Among the diagnostic groups, there was a significant difference regarding the number of implants placed ( p < 0.0001). There was a significant correlation between increased incidence of complications and the size of the bone flaps. Conclusions : The underlying disease influenced significantly the treatment course and the outcome of dental rehabilitation after microvascular jaw reconstruction.

Sickle cell disease (SCD) is a mono-genic disorder causing chronic hemolysis, anemia, and vaso-occlusion, leading to musculoskeletal complications such as osteonecrosis, osteoporosis, and bone fractures affecting 50-70% SCD patients. These complications result from a complex interplay of genetic and physiological factors, including abnormal hemoglobin production, chronic inflammation, and oxidative stress. This review discusses the pathophysiology, pre-clinical symptoms, and clinical manifestations of musculoskeletal complications in SCD, as well as current treatment options, including pharmacological interventions, surgical procedures, and bone marrow transplantation. Early detection of pre-clinical symptoms is crucial to prevent progression. Pharmacological interventions (analgesics, anti-inflammatory agents, bone-modifying agents and hydroxyurea), surgical interventions (core decompression, bone grafting, joint replacement and osteotomy) and supportive measures enhance mobility, strength and well-being. A multidisciplinary approach is essential for optimal care, and early diagnosis and management are crucial to prevent long-term damage and improve outcomes. Future research directions include targeted therapies, biomarker investigation and infrastructure development to improve outcomes for SCD individuals with musculoskeletal complications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: The effects of surgical treatment on the quality of life (QOL) of patients who have osteonecrosis of the femoral head (ONFH) have been rarely reported. This multicenter study aimed to elucidate the longitudinal QOL in patients who have ONFH undergoing total hip arthroplasty., Methods: Self-assessment QOL questionnaires, including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), Oxford Hip Score (OHS), and 12-Item Short-Form Health Survey Version 2 (SF-12v2), were administered to 124 patients at 6 months, 1 year, 2 years, and 5 years postoperatively. These scores were compared according to age, sex, and associated factors from preoperative status to 2 years postoperatively (study 1) and from 2 to 5 years postoperatively (study 2)., Results: Postoperative JHEQ satisfaction, pain, movement, mental, OHS, and SF-12v2 physical component summary (PCS) scores significantly improved 6 months postoperatively. The satisfaction level and OHS in men and patients aged < 60 years continuously improved significantly until 2 years postoperatively. Postoperative JHEQ movement scores gradually improved in patients aged ≥ 60 years. The SF-12v2 role component summary scores improved significantly 2 years postoperatively. Compared to the scores at postoperative 2 years, JHEQ satisfaction level in the patients aged ≥ 60 years and patients who had corticosteroid-associated ONFH, JHEQ pain and mental scores in women and corticosteroid-associated patients, and JHEQ movement and OHS in women improved significantly at 5 years postoperatively. Women showed better pain visual analog scale for up to 5 years postoperatively. The PCS at postoperative 2 years was significantly better in alcohol-associated patients than in patients who have corticosteroid-associated ONFH; however, there were no significant differences at 5 years postoperatively. The PCS was significantly better in patients aged < 60 years and in women at 5 years postoperatively., Conclusions: Longitudinal change in QOL scores of patients who have ONFH who underwent total hip arthroplasty indicated different improvement patterns according to age, sex, and associated factors., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Subchondral insufficiency fractures of the knee (SIFK) are a relatively common cause of knee pain, particularly in middle-aged and older adults. The SIFK is a type of stress fracture that occurs when excessive and repetitive or supraphysiologic loads are applied to subchondral bone [1]. Historically, this type of fracture was termed spontaneous osteonecrosis of the knee (SONK) until advances in MRI identified underlying fractures as well as meniscal deficiency as likely attributable etiologies. Consequently, SIFK has replaced SONK as the more appropriate term to refer to this category of conditions, with SONK now viewed as an advanced SIFK lesion. With greater availability of MRI, SIFK has been more frequently recognized and not as commonly mistaken for knee osteoarthritis as it had been in the past, with important implications for treatment and management of this condition., Competing Interests: Declarations. Conflict of interest: P. Scott, B. Cabarcas and L. Kang declare that they have no competing interests. M. Hevesi: DJO—Enovis: paid consultant; Elsevier: publishing royalties, financial or material support; Journal of Cartilage and Joint Preservation: editorial or governing board; Moximed: paid consultant; Vericel: paid consultant. A.J. Krych: American Journal of Sports Medicine: editorial or governing board; Arthrex, Inc: paid consultant; Arthroscopy Association of North America: board or committee member; International Cartilage Repair Society: board or committee member; Springer: editorial or governing board. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Despite the widespread use of ultrasonography (US) in medical diagnostics, there is no similar US device available for visualizing jawbone density. This study is a narrative review of the possible applications of US in dentistry. This review is divided as follows: (a) Pulse-echo ultrasonography: the applications offer new perspectives for periodontal and peri-implant assessment. (b) Through-transmission alveolar US (TTAU): this technique was a novel imaging modality until 2004, when TTAU devices were last available. Quantitative US scaling made the device useful for diagnosing chronic inflammatory conditions in the jaw. (c) Ultrasound transmission velocity (UTV): in 2008, this technique was introduced in German university dental clinics to analyze the mechanical properties of the jawbone without translating the scientific findings into a practical device. (d) Trans-alveolar US device (TAU): the growing importance of "osteoimmune focal bone marrow defects" has led practitioners to develop a new TAU device. The attenuation of US was used for imaging of jawbone density. (e) Patients who benefit from TAU-guided jawbone surgery: research has shown remarkable results in specific disease cases. This review concludes that US has been undervalued as a diagnostic tool in dentistry. The new TAU-n unit offers the opportunity to change this in the future., Competing Interests: The authors report no conflicts of interest in this work., (© 2025 Huber et al.)

Osteonecrosis of the femoral head (ONFH) is a serious complication in patients with sickle cell disease (SCD), secondary to the peculiar pathophysiology of the disease. SCD is characterized by stiff and adhesive RBCs, disturbing blood circulation, and causing ischemia and microvascular damage. Understanding the key risk factors contributing to ONFH in this population is critical for developing targeted interventions to improve outcomes in this population. This study aimed to identify and analyze the key risk factors associated with osteonecrosis of the femoral head (ONFH) in patients with sickle cell disease (SCD) through a comprehensive systematic review and meta-analysis. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) tool to search and select the most relevant studies from electronic databases, like Web of Science, Google Scholar, PubMed, Cochrane Library, Embase, and MEDLINE, based on the study focus. The following medical phrases were used in the search: femoral head, aseptic necrosis, osteonecrosis, predictor, risk factor, and sickle cell disease. The study included six studies with a total of 581 participants. Four significant risk factors for ONFH in SCD were identified as follows: genotype (risk ratio: 1.09, 95% CI: 0.94-1.27), elevated hemoglobin levels (mean difference: 0.30, 95% CI: -0.03 to -0.63), hip pain (risk ratio: 1.11, 95% CI: 0.80-1.55), and acute chest pain (mean difference: 1.17, 95% CI: 0.87-1.47). Statistical analysis showed low heterogeneity across studies (I²: 0%, p < 0.05), indicating consistent findings. The ONFH group was more significantly affected by these factors than the comparator group. The meta-analysis revealed an intricate interplay of vascular, hematologic, and systemic factors contributing to ONFH of SCD with the four significant risk factors mainly genotype, elevated hemoglobin levels, hip pain, and acute chest pain. Therefore, it is important to carry out regular check-ups and focus on specific treatments to manage these clearly identified risk factors, which can help slow down the progression of the disease., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Hassaan et al.)

The healing of bone defects after debridement in medication-related osteonecrosis of the jaw (MRONJ) is a challenging medical condition with impaired angiogenesis, susceptible infection, and pro-inflammatory responses. Magnesium (Mg) nanocomposite hydrogel is developed to specifically tackle multiple factors involved in MRONJ. Mg-oxide nanoparticles tune the gelation kinetics in the reaction between N-hydroxysuccinimide-functionalized hyperbranched poly (ethylene glycol) and proteins. This reaction allows an enhanced mechanical property after instant solidification and, more importantly, also stable gelation in challenging environments such as wet and hemorrhagic conditions. The synthesized hydrogel guides mandible regeneration in MRONJ rats by triggering the formation of type H vessels, activating Osterix+ osteoprogenitor cells, and generating anti-inflammatory microenvironments. Additionally, this approach demonstrates its ability to suppress infection by inhibiting specific pathogens while strengthening stress tolerance in the affected alveolar bone. Furthermore, the enhanced osteogenic properties and feasibility of implantation of the hydrogel are validated in mandible defect and iliac crest defect created in minipigs, respectively. Collectively, this study offers an injectable and innovative bone substitute to enhance mandible defect healing by tackling multiple detrimental pathologies., (© 2024 The Author(s). Advanced Materials published by Wiley‐VCH GmbH.)

Introduction: Coronavirus disease 2019 (COVID-19) infection or corticosteroid usage during the COVID-19 pandemic as risk factors for avascular necrosis (AVN) of the femoral head (osteonecrosis of the femoral head/femoral head AVN [FHAVN]), as well as its link to clinical and radiological outcomes, are poorly understood. Osteonecrosis, which results from a disruption in vascular supply to the femoral head, is a prevalent cause of hip joint deterioration and one of the most common reasons for total hip arthroplasty (THA)/total hip replacement in India and other Asian countries. This study will aid in understanding the condition's epidemiology and statistically determining the risk of disease related with pandemic exposure., Materials and Methods: This is a retrospective study of 100 hips diagnosed with osteonecrosis/osteoarthritis of the femoral head that underwent THA at a tertiary care center before and after the COVID-19 pandemic between February 2014 and February 2024., Results: Late stages of FHAVN, when the diagnosis requiring THA, following the pandemic have increased exponentially. It has also switched from affecting the middle-aged to the younger age groups. Furthermore, the bilaterality necessitating THA has increased considerably. There is a clear shift in the presentation of this disabling illness, as well as the need for THA, which otherwise is rarely carried out on younger people. Furthermore, data on how much corticosteroids were used in the treatment is disturbingly scant, and how it may have contributed to this ailment in India is still questionable., Conclusion: The COVID-19 pandemic could be the most serious threat, causing late-stages FHAVN (stages 3 and 4 of the Ficat and Arlet classification), in an accelerated manner, necessitating THA and overburdening existing medical care., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Bisphosphonates (BPs) are widely used for osteoporosis and cancer-induced bone diseases due to their antiresorptive properties, yet they pose risks such as medication-related osteonecrosis of the jaw (MRONJ)., Methods: We present a unique case of concurrent oral squamous cell carcinoma (SCC) and MRONJ in a 72-year-old female chronically treated with oral ibandronate for osteoporosis. Following a dental extraction, she developed a nonhealing wound in the maxilla. Following conservative treatment, the patient underwent a maxillectomy and extensive tissue reconstructions to control her infection and address suspicions of an underlying malignancy., Results: Histopathological examinations confirmed simultaneous osteonecrosis and well-differentiated SCC in the maxillary sinus and surrounding tissues. Despite multiple surgeries, the patient's disease progressed rapidly. Upon examining the literature for patients with a history of BP use diagnosed with MRONJ and/or SCC, a total of 16 cases report a diagnostic dilemma between MRONJ and locoregional SCC. Three of the 16 cases report a final diagnosis of concurrent MRONJ and SCC. This report is the fourth reported case of concurrency to date., Conclusions: The patient's complex clinical course underscores the diagnostic challenges and therapeutic dilemmas in managing concurrent MRONJ and SCC, highlighting the need for vigilant monitoring and interdisciplinary collaboration in similar cases., (© 2024 Wiley Periodicals LLC.)

Avascular necrosis (AVN) is a prevalent and progressive complication in young patients with sickle cell disease (SCD), but no study evaluated the long-term subjective and objective outcome measures. Oxford hip score (OHS) and Oxford shoulder scores (OSS) are validated joint-specific patient-reported outcome measures (PROMs). In this prospective multicentre study, 47 SCD patients with pre-existing diagnosis of AVN occurred at a median age of 35.9 (24.2-47.6) filled out the OHS and OSS at median follow-up of 9.4 years (4.5-12.9). No patient died after diagnosis of AVN. Hip AVN was present in 34 (72%) patients, with bilateral involvement in 25 (74%); 26 (59%) underwent total hip arthroplasty (THA) at a median age of 34.6 (22.6-49.5); and 4 (15%) required re-surgery. OHS revealed moderate to severe impairment both in patients underwent THA and no hip surgery. Shoulder AVN was present in 13 (6%) patients and OSS revealed mild to moderate impairment. A high rate of compromised joint function and pain was observed 10 years after diagnosis of AVN regardless of the type of treatment, outlying the need to improve the management of this sickle-related complication. OHS and OSS are validated joint-specific PROMs easy to use in all SCD centres., (© 2024 The Author(s). British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

The humeral head is the second most common anatomical site of osteonecrosis after the femoral head. Studies have reported satisfactory clinical outcomes after shoulder arthroplasty to treat osteonecrosis of the humeral head (ONHH). However, there are concerns regarding implant longevity in relatively young patients. This study investigated the effectiveness of non-operative treatment for atraumatic ONHH in relatively young patients. Thirty-two patients (41 shoulders, 9 bilateral) were included and received non-operative ONHH treatment consisting of pain management and self-stretching exercises. Treatment failure was defined as conversion to surgical treatment owing to difficulty performing activities of daily living with resting pain (Visual Analog Scale [VAS] ≥ 6) after 6 months of staged treatment. The mean follow-up was 73.6 months. The mean ONHH stage was 3.6 initially and 3.8 at final follow-up. Stage progression was observed in 14.6% (6/41) of the shoulders. No treatment failures occurred during follow-up. Between the initial visit and final follow-up, no significant differences in clinical outcomes, including resting pain, Single Assessment Numeric Evaluation score, forward flexion, and external rotation were observed; only internal rotation range of motion was observed to significantly decrease (p < 0.001). Non-operative treatment showed satisfactory results in relatively young patients with advanced atraumatic ONHH., Competing Interests: Declarations. Informed consent: Patient consent was waived owing to the retrospective nature of the study, and the analysis used anonymous clinical data. Competing interests: The authors declare no competing interests. Institutional review board statement: Institutional Review Board of Severance Hospital waived Informed Consent due to the retrospective nature of the study, and the analysis used anonymous clinical data., (© 2024. The Author(s).)

Introduction: Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a promising treatment for hematological malignancies. However, its association with immune-related complications such as rheumatic complications, is not well defined., Methods: We conducted a retrospective study to analyze rheumatic complications in 310 patients treated with CAR-T therapy at a single center from January 2020 to May 2024., Results: We identified six patients (1.9 %) who developed rheumatic complications, including rheumatoid arthritis (RA)-like manifestations with biopsy-proven nodules, palindromic rheumatism, myositis, necrotizing fasciitis, and osteonecrosis (ON). Symptoms appeared between 2 to 11 weeks after therapy, with inflammatory arthritis manifesting later. Notably, 2 patients developed RA-like arthritis with subcutaneous nodulosis, while others presented with transient arthritis flares, severe soft tissue and joint involvement, such as pseudo-podagra and ON. Imaging findings and biopsies confirmed the diagnoses. Treatment included glucocorticoids, hydroxychloroquine, and nonsteroidal anti-inflammatory drugs, with variable responses., Conclusions: Clinicians should be aware of these potential complications to ensure prompt diagnosis and management. Further research is needed to elucidate the mechanisms underlying these autoimmune phenomena and to establish standardized treatment protocols., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Osteonecrosis of the jaw resulting from the adverse effects of medical treatments is known as medication-related osteonecrosis of the jaws (MRONJ). The knowledge of dental professionals about this condition is crucial in addressing it on a regional and global scale. This study aims to assess the knowledge and awareness of MRONJ among dental practitioners in Mumbai., Materials and Methods: This descriptive cross-sectional study utilized a web-based questionnaire comprising 21 questions distributed to dental professionals and postgraduate students at dental colleges, hospitals, and private practices in Mumbai., Results: A total of 403 dentists participated in the survey, with 85% familiar with the condition. A significantly (p < 0.05) higher proportion of clinicians with over 20 years of experience and those specializing in oral and maxillofacial surgery were aware of the indications for bisphosphonate drugs. About 53% of oral surgeons and 57.7% of participants with more than 20 years of experience were aware that antiangiogenic drugs are used in breast cancer treatment. However, awareness of their use in lung cancer was only about 21%., Conclusions: Although practitioners were familiar with the term MRONJ, their knowledge of the drugs affecting the disease, as well as its clinical and radiographic presentations, was inadequate. Awareness of treatment strategies and recent advances was particularly lacking among general dentists and other specialists apart from oral and maxillofacial surgeons (OMFS). Practitioners also identified a lack of an interdisciplinary approach. There is a clear need for enhanced education and awareness on this subject, which can be achieved by conducting interdisciplinary surveys, conferences, and seminars., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Biomedical Ethics Committee issued approval IEC341072022. The study protocol was approved by the Institutional Review Board of the Bharati Vidyapeth Dental College and Hospital, Navi Mumbai. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shapurwala et al.)

Core decompression was developed as a joint-preserving procedure for patients with early-stage osteonecrosis of the femoral head. Previous studies indicated a high success rate that outperforms nonoperative management of pre-collapse hips. The traditional single-tunnel core decompression technique uses a cannulated drill bit inserted into the lateral cortex of the proximal femur. Multiple small drilling was introduced to decrease the risk of fracture through a less invasive technique. Adjunctive therapeutics such as tantalum rods, bone-grafting, orthobiologic (e,g, bone marrow aspirate concentrate, mesenchymal stem cells, platelet-rich plasma, and human umbilical cord mesenchymal stem cell extracts) as well as electric stimulation have all been studied. No consensus regarding the ideal treatment has been reached. This review analyzes the advantages and disadvantages of current core decompression techniques to provide orthopaedic surgeons with direction in managing patients with avascular necrosis of the femoral head., Competing Interests: Declarations. Competing interests: All other authors have no disclosures., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective  The management of slipped capital femoral epiphysis (SCFE) has been completely transformed by modified Dunn osteotomy, a subcapital realignment osteotomy achieved through a safe surgical dislocation technique originally described by Ganz. The purpose of this study was to evaluate the clinical and radiological outcomes of patients with moderate to severe SCFE after modified Dunn osteotomy. Methods  A total of 15 patients (16 hips, with one bilateral case; 12 males, 3 females) aged from 10.2 to 17-years-old (mean: 14.3) with stable, moderate to severe, chronic SCFE (moderate: = 6; severe = 10) underwent modified Dunn osteotomy as treatment. The hip joint range of motion (ROM), Harris (HHS), and Merle d'Aubigné (MdA) hip scores were used for clinical assessments. They were assessed radiographically using the Southwick and Alpha angles. Results  At the most recent follow-up (mean 8.6 years; 3.1-14), the mean hip joint ROM, the mean HHS (preoperative: 69.20 ± 5.94; postoperative: 86 ± 7.37; p  < 0.00001), and the mean MdA score (preoperative: 12.47 ± 1.13; postoperative: 14.27 ± 1.83; p  < 0.00001) all showed statistically significant clinical improvements The radiological results demonstrated improvements in the mean Southwick angle (preoperative: 56.60 ± 12.89°; postoperative: 16.40 ± 4.69°; p  < 0.00001) and Alpha angle (preoperative: 101.87 ± 12.88°; postoperative: 29.33 ± 7.29°; p  < 0.00001). There were two significant postoperative complications identified: femoral head avascular necrosis (AVN) and deep infection. Conclusion  According to the study's findings, the modified Dunn osteotomy is a safe, efficient treatment option for stable moderate-to-severe chronic SCFE with a manageable risk of complications., Competing Interests: Conflito de Interesses O autor não tem conflito de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious, debilitating condition of the jaw bones. Dental extraction is the most significant independent risk factor for MRONJ. This interim study aimed to evaluate the demographics, medical data and outcomes of patients at risk for MRONJ who underwent dental extractions in a dedicated MRONJ clinic following a risk reduction protocol at a large public dental clinic in New South Wales Health., Methods: A retrospective study analysed demographic and clinical data of patients at risk for MRONJ who underwent dental extractions between March 2020 and April 2024., Results: Data from 329 at-risk patients who underwent 836 dental extractions were included. Most patients were women (75.1%) with a median age of 74 years (IQR 67-80). The primary indication for medications was osteoporosis (85.4%), with Denosumab being the most frequently prescribed (66.9%). Eighteen patients (5.5%) developed MRONJ at 8 weeks of follow-up. Patients categorized as high-risk had a higher incidence of MRONJ (72.2%) compared to the low-risk group (22.2%)., Conclusion: This study is the first retrospective audit carried out after implementing preventive protocols in this dedicated MRONJ clinic. The higher incidence of MRONJ in patients classified as 'high risk' underscores the importance of considering individual risk factors in their treatment., (© 2024 Australian Dental Association.)

Introduction: Short stem total hip arthroplasty (THA) is an alternative to conventional stem, designed to facilitate minimal-invasive surgery, physiological loading and preserve bone stock. However, there is insufficient evidence of the long-term outcomes in patients with osteonecrosis of the femoral head (ONFH). This study aims to analyze the clinical and radiographic results with a minimum follow-up of 10 years. Furthermore, the survival rate of the short stem was calculated., Materials and Methods: There were 81 patients (101 hips) with the mean age of 45 years (range, 21 to 68) in this study. The Harris Hip Scores (HHS) and Forgotten Joint Scores (FJS) were recorded to evaluate the clinical results. The appearance of osteointegration and radiolucent line were reviewed. The mean follow-up period was 129.3 months (range, 120-154)., Results: At the latest follow-up, the mean HHS and FJS were 96.9 ± 5.7 (range, 69-100) and 95 ± 7 (range, 75-100) points respectively. The radiographic changes around the stem showed osteointegration mainly in the proximal part, zones 1 (94.1%), 2 (84.2%), 6 (99%) and 7 (92.1%). One stem underwent revision due to periprosthetic fracture, using conventional stem with plate and screws. Survivorship of the stem with the endpoint for any reason was 99.01% (95% confidence interval [CI], 93.18-99.86%) and for aseptic loosening was 100% at 10 years., Conclusion: Short stem showed promising long-term clinical outcomes in patients with ONFH. The radiographic results demonstrated physiological proximal load transfer., Competing Interests: Declarations. Ethical approval: Approval was obtained from the institutional review board, Maharat Nakhon Ratchasima Hospital, Thailand (015/2024). Informed consent: Informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Medication-related osteonecrosis of the jaw (MRONJ) is a progressive condition that can cause significant bone loss and its diagnosis can be challenging. A 68-year-old man with a diagnosis of hepatocellular carcinoma, undergoing treatment with atezolizumab, bevacizumab and zoledronic acid, complained of spontaneous pain in the right lower second premolar. Oral examination revealed no dental changes and implants in the right jaw. A patient history and thorough clinical and radiographic examinations mimic endodontic disease. The implant crowns were removed, bleeding on probing, and peri-implant pockets were observed. The main hypothesis was MRONJ Stage 2, and the surgical treatment was performed. The pain ceased and signs of MRONJ were not observed within 3 months. MRONJ should be considered as a hypothesis in the case of odontalgia and a patient's history of antiresorptive and antiangiogenic therapies. Furthermore, monitoring patients with dental implants in the mandible through detailed clinical and imaging evaluation is required., (© 2024 Australian Society of Endodontology Inc.)

Histomorphometry is an important technique in the evaluation of non-traumatic osteonecrosis of the femoral head (ONFH). Quantification of empty lacunae and pyknotic cells on histological images is the most reliable measure of ONFH pathology, yet it is time and manpower consuming. This study focused on the application of artificial intelligence (AI) technology to tissue image evaluation. The aim of this study is to establish an automated cell counting platform using YOLOv8 as an object detection model on ONFH tissue images and to evaluate and validate its accuracy. From 30 ONFH model rabbits, 270 tissue images were prepared; based on evaluations by three researchers, ground truth labels were created to classify each cell in the image into two classes (osteocytes and empty lacunae) or three classes (osteocytes, pyknotic cells, and empty lacunae). Two and three classes were then annotated on each image. Transfer learning based on annotated data (80% for training and 20% for validation) was performed using YOLOv8n and YOLOv8x with different parameters. To evaluate the detection accuracy of the training model, the mean average precision (mAP (50)) and precision-recall curve were identified. In addition, the reliability of cell counting by YOLOv8 relative to manual cell counting was evaluated by linear regression analysis using five histological images unused in previous experiments. The mAP (50) for the detection of empty lacunae was 0.868 for the YOLOv8n and 0.883 for the YOLOv8x. The mAP (50) for the three classes was 0.735 for the YOLOv8n model and 0.750 for the YOLOv8x model. The quantification of empty lacunae by automated cell counting obtained in the learning was highly correlated with the manual counting data. The development of an AI-applied automated cell counting platform will significantly reduce the time and effort of manual cell counting in histological analysis., (© 2024 Wiley Periodicals LLC.)

Medication-related osteonecrosis of the jaw (MRONJ) is an intractable condition caused by drugs such as bisphosphonates and denosumab. This study investigated the changes in the incidence of MRONJ in the previous 10 years and examined the poor prognostic factors during surgery in at-risk patients. We compared 57 and 64 patients diagnosed with MRONJ at our hospital between January 2012 and December 2016 and January 2017 and December 2021, respectively. The disease stage and triggers at the time of initial diagnosis in eligible patients were investigated. Additionally, the adverse prognostic factors were examined in 166 patients at risk of MRONJ who underwent tooth extraction at our department during these 10 years. The results indicated that there was no change in the proportion of patients with osteoporosis and malignancy among those with MRONJ. The number of cases after tooth extraction decreased, and those after dental infections increased on comparing the recent 5 years and the preceding 5 years. The number of MRONJ patients receiving denosumab also increased. Denosumab was a significant post-extraction prognostic factor for delayed healing in the 166 patients at risk of MRONJ. The findings suggest that patients receiving denosumab should be closely monitored when undergoing surgery to prevent MRONJ., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Spontaneous osteonecrosis of the knee (SONK) was first described by Ahlbäck et al. in 1968. However, subsequent studies revealed that subchondral fractures, rather than necrosis, are the most common histopathological finding in bone samples from patients diagnosed with SONK. This has led to ongoing debate regarding the accuracy of the term "SONK." Therefore, SONK is an inappropriate definition for this condition since the absence of necrosis in most histopathological samples of patients with such diagnosis. A PRISMA-compliant scoping review was conducted using PubMed, Scopus, and Cochrane databases. All original research studies reporting histological analyses of bone samples from patients who underwent surgery following a diagnosis of SONK were considered for inclusion. Extracted data included general study characteristics, radiographic and magnetic resonance imaging (MRI) findings, time elapsed between arthroscopy and histological sampling, and the results of histological examinations of bone samples. Eight articles met the inclusion criteria, comprising 90 patients (91 knees), of which 87 bone samples were analyzed histologically. Of these, 7 showed undetermined outcomes. Among the remaining 80 samples, necrosis was identified in 35 cases and absent in 45. Subchondral insufficiency fractures (SIFs) were detected in 41 cases, with 19 of these also showing necrosis. The histopathological evidence suggests that the term "SONK" is inappropriate, as SIFs, rather than necrosis, are the predominant finding. We therefore recommend adopting "SIF" as a more accurate descriptor for this condition., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest, (© 2024. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.)