Hip-preserving treatment of early ONFH via arthroscopy: preoperative finite element analysis planning with 3D printing assistance

Osteonecrosis of the femoral head (ONFH) is caused by the disruption of blood flow in the femoral head, leading to irreversible necrosis. Early intervention in ONFH is crucial to prevent femoral head collapse, preserve joint function, and delay or avoid the need for hip replacement. Currently, hip-preservation strategies for early ONFH face two significant technical challenges: (a) achieving precision targeting with minimal iatrogenic injury. (b) Precisely identify and target biomechanically optimal 3D location. This study combined hip arthroscopy ‌with‌ preoperative finite element mechanical analysis, ‌supplemented by‌ 3D printing technology, ‌aiming to propose a new strategy to guide the precision treatment for early ONFH. Patients treated by this strategy showed a significant decrease in Visual Analogue Scale (VAS) scores from preoperative to 14 days postoperatively, while Harris Hip score (HHS) showed a significant improvement from preoperative to 3-month postoperative follow-up. Of note, imaging results showed that no patient had ONFH progression within 3 years after surgery. This strategy realizes finite element analysis to preoperative planning guidance, practices the biomechanical treatment for early ONFH, worthing further studying and popularizing.