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OBJECTIVE: Although the therapeutic efficacy of conventional core decompression (CD) for the early-stage osteonecrosis (ON) has been widely investigated in the literature, no study to date has specifically focused on its therapeutic effect on the long-term outcome of ON of the femoral head (ONFH) in systemic lupus erythematosus (SLE). This study aimed to provide a long-term survival analysis of all hips that underwent conventional CD for the management of ONFH in a consecutive case series of patients with SLE. PATIENTS AND METHODS: Sixteen hips of 10 consecutive SLE patients that underwent conventional CD for the management of ONFH in a single tertiary referral center were retrospectively identified and included in the study. After a retrospective chart review, several clinical and radiological data were recorded. RESULTS: All the hips treated with CD were stage I or IIA sclerotic and/or cystic based on the classification system of Ficat. Only the 2 hips of 1 patient (12.5%) survived both clinically and radiographically. The median overall survival for all hips after CD was 80 months (95% CI, 60-100). The 5-, 10-, and 15-year survival rates of hip joints following CD were 63%, 31%, and 12.5%, respectively (CI 95% 63.567 to 133.058 months). CONCLUSIONS: Conventional CD may not be effective in preventing the progression of pre-collapse ONFH to collapse and eventually end-stage osteoarthritis requiring arthroplasty in patients with SLE. [ABSTRACT FROM AUTHOR]