Osteonecrosis of the femoral head (ONFH) has an exceedingly high prevalence and disability rate, causing a tremendous socioeconomic burden. The prevalence of ONFH is increasing, while the population of the patients with ONFH is becoming younger. Once the femoral head collapses, treatment becomes difficult and often requires a hip joint replacement, which is not favorable for young patients. Therefore, hip joint-preserving treatments at an early stage of ONFH are particularly important. This study provides a comprehensive review on hip-preserving strategies for treating ONFH, including nonoperative treatments (e.g., protective weight bearing, hyperbaric oxygen, pulsed electromagnetic, extracorporeal shockwave, bisphosphonate, anticoagulants, hypolipidemics, vasodilators, and traditional Chinese medicine) and operative treatments (e.g., core decompression, osteotomy, bone grafting, mesenchymal stem cell transplantation, tantalum rods, and tissue engineering). Nonoperative treatments aim to slow down the progression of the disease and delay the need for joint replacement; however, they usually cannot effectively prevent the progression of the disease, except in cases of small necrosis areas (<10 %). Additionally, nonoperative treatments have unclear mechanisms that require further investigation. In contrast, operative treatments may stop the negative outcomes of necrosis and therefore appear to be more promising. Currently, an emerging area in operative treatments is regenerative medicine, which could promote the generation of bone tissues and blood vessels and restore hip joint function to pre-necrotic levels as much as possible. This review seeks to not only provide an important reference for clinicians when choosing appropriate strategies for treating ONFH but also offer certain guidance for future basic research in developing ONFH treatments. The incidence of ONFH is increasing, and patients are becoming younger on average. Therefore, the development of hip joint-preserving strategies to treat ONFH at earlier stages is urgently needed, particularly for young patients. However, a comprehensive review is lacking regarding the currently-available hip joint-preserving strategies and their effectiveness. This study is motivated to fill this gap and serve as an important reference for clinicians in choosing appropriate strategies to treat ONFH.

Background: Osteonecrosis of the femoral head (ONFH) is a severe complication of systemic lupus erythematosus (SLE). However, the demographic characteristics, glucocorticoids (GCs) risks, and other contributing factors remain debated. Objective: To elucidate the population characteristics, GCs-related risks, and other risk factors for ONFH in patients with SLE through a systematic review and meta-analysis, thereby enhancing the clinical identification of high-risk populations and optimizing GCs therapy strategies in SLE. Methods: We searched seven databases, from their inception until July 2025 for relevant cohort and case-control studies. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results: Thirty-five studies involving 11,356 participants were included. Regarding population characteristics, patients with SLE who developed ONFH had a significantly younger age at diagnosis (SMD = -0.19, P < 0.00001) and higher SLEDAI scores (SMD = 0.21, P = 0.002). Among metabolic and immune indicators, elevated triglycerides (SMD = 0.21, P = 0.02), decreased high-density lipoprotein cholesterol (SMD = -0.22, P = 0.03), and positive antiphospholipid antibodies (OR = 2.00, P = 0.04) were associated with ONFH occurrence. Regarding GC therapy, pulse steroid therapy (OR = 2.02, P < 0.00001), an initial dose >60 mg/day (OR = 4.19, P < 0.0001), a maximum daily dose >50 mg (SMD = 0.42, P = 0.0002), and higher average daily GC intake (SMD = 0.32, P = 0.004) significantly increased ONFH risk. In contrast, cumulative GC dose showed no significant association ( P = 0.14). Furthermore, vasculitis (OR = 3.17, P < 0.00001), hypertension (OR = 1.48, P = 0.02), Raynaud’s phenomenon (OR = 1.60, P = 0.0003), thrombocytopenia (OR = 1.69, P = 0.007), and arthritis (OR = 1.88, P = 0.006) were identified as independent risk factors. Conclusion: Patients with SLE at high risk for ONFH exhibit distinct characteristics. Short-term high-dose GC exposure, rather than cumulative dose, constitutes the core medication-related risk. Enhanced imaging screening and comprehensive, multi-factorial prevention strategies are warranted, particularly for patients receiving high initial doses or pulse therapy. Clinical management should focus on optimizing GC regimens in these high-risk individuals to minimize the occurrence of ONFH. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251084371 , identifier CRD420251084371.

Background: Knee osteoarthritis (KOA) is the most prevalent musculoskeletal degenerative disease worldwide. Periarticular muscle abnormalities are considered closely associated with its pathogenesis, yet the relationships between various muscle parameters and KOA remain controversial. Objective: To clarify the correlations of thigh muscle quantity, muscle quality, and muscle strength with KOA through a systematic review and meta-analysis, and to provide evidence-based support for the risk screening and early intervention of KOA in high-risk populations. Methods: Relevant cross-sectional, cohort, and case-control studies published up to March 2026 were searched in PubMed, Embase, and MEDLINE (accessed via the Ovid). Methodological quality was assessed using the AHRQ scale for cross-sectional studies and the Newcastle-Ottawa Scale for cohort and case-control studies. Meta-analyses were performed using RevMan 5.3 software, and subgroup analyses stratified by study design were conducted to explore sources of heterogeneity. Results: A total of 24 studies involving 10,300 participants were included. Patients with KOA showed significantly increased cross-sectional areas of sartorius muscle (SMD = 0.09, P = 0.002) and flexor muscles (SMD = 0.09, P = 0.0008), and markedly reduced thickness of vastus lateralis muscle (SMD=-0.61, P = 0.03). Intermuscular adipose tissue content was significantly higher in KOA patients than in healthy controls (SMD = 0.35, P = 0.001). For muscle strength, KOA patients exhibited significant reductions in knee extensor torque (SMD=-1.09, P = 0.0001), extensor strength (SMD=-0.16, P = 0.0002), knee extensor relative strength (SMD=-0.15, P = 0.04), flexor torque (SMD=-0.95, P = 0.04), and flexor strength (SMD=-0.12, P = 0.004). Substantial heterogeneity was observed in key outcomes including knee extensor torque (I²=97%), knee flexor torque (I²=99%) and intermuscular adipose tissue (I²=72%). Low knee extensor strength was associated with a 1.45-fold increased odds of KOA (OR = 1.45, P = 0.01), and this association was more prominent in women (OR = 1.54, P = 0.0006). Conclusion: Alterations in thigh muscle quantity, quality and strength are significantly associated with KOA, particularly increased intermuscular adipose tissue infiltration and decreased knee extensor strength. Current evidence is predominantly derived from cross-sectional and case-control studies, and causal inferences cannot be established. These muscle parameters may serve as potential indicators for KOA risk stratification, and their predictive value and clinical utility require further verification in large-scale prospective cohort studies. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261350323 , identifier CRD420261350323.