Besides, some RCT researches were designed to compare different surgical interventions for ONFH, including CD, DD, bone transplantation (VFG, FVFG, VIPBG, and IFHG), Osteotomy, and TI. In a large number of studies, the clinical effect of ESWT which was assessed from a comprehensive perspective showed better effect than other conservative therapeutic methods. Nowadays, the treatment and management for ONFH consists of conservative and surgical approaches. The principle of ONFH treatment includes the termination of pathologic progression and the restoring of weight-bearing capacity.
Therefore, how to retard the progression of ONFH is always a research hotspot. ONFH is histologically characterized by insufficient supply of blood, death of osteocytes, and bone marrow cells, as well as progressive structure damage of involved bones, which typically follows a progressive course leading to femoral head collapse and hip joint destruction. In the United States, ONFH is reported to affect 20,000 patients each year, and it is estimated that more than 10% of ONFN patients eventually required total hip arthroplasties (THA) annually. Osteonecrosis of the femoral head (ONFH) is a debilitating disorder with a considerably high incidence in individuals aged between the third and fifth decades of life. ESW therapy (ESWT) is the most effective intervention to improve HHS, and VFG shows superior effect on reducing treatment failure rates. In femoral necrosis stage-II, VFG achieved the highest probability in preventing treatment failures (52%) and showed better performance in reducing treatment failure rates than CD. In the meanwhile, VFG also proved to be superior in reducing the failure rates of treatment (probability lowest 59%), followed by ESW (probability lowest 24%). ESW had the highest improvement on Harris score (probability best 52%), followed by VFG (probability was 38%). A total of 14 randomized controlled trials were investigated. The primary outcome was Harris score the secondary outcome was Harris hip score (HHS), including total hip arthroplasty requirement (THA) and progression to collapse. Treatment methods included extracorporeal shockwave (ESW), core decompression (CD), multiple drilling decompression (DD), vascularized fibular grafting (VFG), free-vascularized fibular grafting (FVFG), inverted femoral head grafting (IFHG), vascular iliac pedicle bone grafting (VIPBG), osteotomy, and tantalum implantation (TI). Electronic literature, for studies published up to December 2017, was collected from PubMed, Medline, and the Cochrane Library. This is a systematic review of previous literature and in-depth Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the clinical effect of various operation methods and one physical intervention (extracorporeal shockwave). To assess the effectiveness of various therapeutic hip preservation strategies on patients with nontraumatic osteonecrosis of the femoral head (ONFH).