Correlation between continuation of glucocorticoid treatment and risk of femoral head collapse

A retrospective cohort study of patients with glucocorticoid-induced osteonecrosis of femoral head after hip-preserving interventions
  • Zhongxin Zhu
  • Shaoguang Li
  • Huan Yu
  • Jiaxin Huang
  • Peijian TongEmail author



To evaluate the correlation between continuation of glucocorticoid (GC) treatment and risk of femoral head collapse in patients with glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) after hip-preserving interventions.


The cohort included patients with GIONFH who had received a hip-preserving intervention between 1 January 2014 and 1 April 2016. All hips were at the non-collapse stage. The independent variable and the dependent variable were postoperative GC use and femoral head collapse (≥3 mm), respectively. Multivariate Cox proportional hazards regression were performed to estimate the association of the variables after adjusting for other covariates.


A total of 27 hips (24 patients) were included for the final data analysis of which 6 hips out of 18 developed femoral head collapse (≥3 mm) in patients who discontinued taking GC postoperatively and 6 hips out of 9 developed collapse (≥3 mm) in those requiring GC treatment postoperatively. In the fully adjusted Cox proportional hazards model, the risk of femoral head collapse (≥3 mm) was higher in participants requiring postoperative GC use than those not requiring GC (hazard ratio, HR 3.7, 95% confidence interval, CI 1.1–13.0).


The results of this study demonstrated that patients with GIONFH who continued GC treatment postoperatively had a significantly increased risk of femoral head collapse (≥3 mm) compared to those who discontinued use of GC.


Retrospective study Adverse effects Osteonecrosis Quality of life Outcome 



Activities of daily living


Association Research Circulation Osseous


Body mass index


Core decompression


Confidence interval




Glucocorticoid-induced osteonecrosis of the femoral head


Hazard ratio


Peripheral blood stem cells


Strengthening the reporting of observational studies in epidemiology

Korrelation zwischen der Fortsetzung der Glukokortikoidbehandlung und dem Risiko eines Hüftkopfeinbruchs

Eine retrospektive Kohortenstudie zu Patienten mit glukokortikoidinduzierter Osteonekrose des Femurkopfes nach hüfterhaltenden Operationen



Der Zusammenhang zwischen der Fortsetzung der Glukokortikoid(GC)-Behandlung und dem Risiko eines Hüftkopfeinbruchs bei Patienten mit glukokortikoidbedingter Osteonekrose des Hüftkopfes (GIONFH) nach hüfterhaltenden Eingriffen wurde untersucht.


In die Kohorte wurden Patienten mit GIONFH eingeschlossen, die zwischen dem 1. Januar 2014 und dem 1. April 2016 eine hüfterhaltende Operation erhalten hatten. Alle Hüften befanden sich in einem Stadium ohne Hüftkopfeinbruch. Die unabhängige sowie die abhängige Variable waren postoperativer GC-Einsatz bzw. Hüftkopfkollaps (≥3 mm). Eine multivariate Analyse mittels proportionaler Hazardregression nach Cox wurde durchgeführt, um die Assoziation der Variablen nach Anpassung anderer Kovariablen zu schätzen.


Insgesamt 27 Hüften (24 Patienten) wurden für die abschließende Datenanalyse einbezogen. Hiervon trat in 6 von 18 Hüften ein Hüftkopfeinbruch (≥3 mm) bei Patienten auf, welche die GC-Einnahme postoperativ beendeten. Bei den Patienten, die eine postoperative GC-Behandlung benötigen, kam es in 6 von 9 Hüften zu einem Einbruch (≥3 mm). Im vollständig angepassten proportionalen Cox-Hazard-Modell lag das Risiko eines Hüftkopfeinbruchs (≥3 mm) bei den Patienten, die eine postoperative GC-Anwendung benötigen, höher als bei denjenigen, die keine GC benötigen (Hazard-Ratio [HR] 3,7; 95% Konfidenzintervall [KI] 1,1–13,0).


Die Ergebnisse dieser Studie zeigten, dass Patienten mit GIONFH, bei denen die GC-Behandlung postoperativ fortgeführt wurde, ein signifikant erhöhtes Risiko für einen Hüftkopfeinbruch hatten (≥3 mm) im Vergleich zu den Patienten, bei denen die GC-Gabe eingestellt wurde.


Retrospektive Studie Unerwünschte Ereignisse Osteonekrose Lebensqualität Outcome 



This study was supported by the National Natural Science Foundation of China (No. 81873324).

Author Contribution

ZXZ and PJT contributed to the study design and writing of the manuscript. ZXZ, SGL, HY, JXH, and PJT contributed to data collection, analysis and interpretation.

Compliance with ethical guidelines

Conflict of interest

Z. Zhu, S. Li, H. Yu, J. Huang and P. Tong declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board of the First Affiliated Hospital of Zhejiang Chinese Medical University approved this study (protocol number: 2019-KL-072-01). All participants provided informed consent.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

Authors and Affiliations

  • Zhongxin Zhu
    • 1
    • 2
  • Shaoguang Li
    • 1
    • 2
  • Huan Yu
    • 1
    • 2
  • Jiaxin Huang
    • 1
    • 2
  • Peijian Tong
    • 2
    • 3
    Email author
  1. 1.Zhejiang Chinese Medical UniversityHangzhouChina
  2. 2.Institute of Orthopedics and Traumatology of Zhejiang ProvinceHangzhouChina
  3. 3.Department of Orthopedic SurgeryThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina

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