Li X, Teng ZW, Pu HJ. Letter to the Editor: Re-evaluating conservative hip preservation in osteonecrosis of the femoral head: Lessons from long-term follow-up. World J Orthop 2026; 17(6): 116685 [DOI: 10.5312/wjo.v17.i6.116685]
Corresponding Author of This Article
Hong-Ji Pu, MD, Associate Professor, MBBS, Department of Medical Imaging, School of Stomatology, Affiliated Stomatological Hospital, Qujing University of Medicine and Health Sciences, No. 1 Longdong Road, Malong District, Qujing 655000, Yunnan Province, China. hongji_pu@sina.com
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Orthopedics
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letter
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Li X, Teng ZW, Pu HJ. Letter to the Editor: Re-evaluating conservative hip preservation in osteonecrosis of the femoral head: Lessons from long-term follow-up. World J Orthop 2026; 17(6): 116685 [DOI: 10.5312/wjo.v17.i6.116685]
World J Orthop. Jun 18, 2026; 17(6): 116685 Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.116685
Letter to the Editor: Re-evaluating conservative hip preservation in osteonecrosis of the femoral head: Lessons from long-term follow-up
Xia Li, Zhao-Wei Teng, Hong-Ji Pu
Xia Li, Hong-Ji Pu, Department of Medical Imaging, School of Stomatology, Affiliated Stomatological Hospital, Qujing University of Medicine and Health Sciences, Qujing 655000, Yunnan Province, China
Xia Li, Zhao-Wei Teng, The Second Affiliated Hospital of Kunming Medical University, Key Laboratory of Neurological and Psychiatric Disease Research of Yunnan Province, Yunnan Provincial Department of Education Gut Microbiota Transplantation Engineering Research Center, Kunming 650106, Yunnan Province, China
Co-first authors: Xia Li and Zhao-Wei Teng.
Author contributions: Li X, Teng ZW, and Pu HJ contributed to the conceptualization, design, intellectual construction and writing of the letter; Li X and Teng ZW contributed equally to this manuscript and are co-first authors. All authors read and approved the final version for publication.
Supported by National Natural Science Foundation of China, No. 82460289; and the Yunnan Provincial Health Commission - Yunnan Provincial Health Commission Medical Discipline Leader Training Program, No. D-2024018.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Hong-Ji Pu, MD, Associate Professor, MBBS, Department of Medical Imaging, School of Stomatology, Affiliated Stomatological Hospital, Qujing University of Medicine and Health Sciences, No. 1 Longdong Road, Malong District, Qujing 655000, Yunnan Province, China. hongji_pu@sina.com
Received: November 24, 2025 Revised: January 6, 2026 Accepted: January 20, 2026 Published online: June 18, 2026 Processing time: 207 Days and 18.4 Hours
Abstract
Osteonecrosis of the femoral head (ONFH) remains a clinically challenging orthopedic condition that affects young and middle-aged adults predominantly. The recent study by Chen et al, published in the recent issue of the World Journal of Orthopedics, provides valuable long-term evidence supporting the efficacy of conservative hip preservation strategies, demonstrating favorable outcomes in select patients with careful follow-up. This letter emphasizes the significance of reappraising non-surgical interventions as part of a comprehensive treatment paradigm. Beyond symptomatic relief, conservative approaches may contribute to delaying femoral head collapse and postponing the need for arthroplasty. Nonetheless, several questions remain, particularly regarding patient selection criteria, radiological predictors, and integration of biological adjuvants to enhance bone repair. Future research combining advanced imaging, molecular biomarkers, and biomechanical assessment may refine individualized therapeutic strategies. The present commentary underscores the importance of sustained evidence-based evaluation and multidisciplinary collaboration to optimize hip preservation outcomes for patients with osteonecrosis of the femoral head.
Core Tip: This letter evaluates a study by Chen et al, describing conservative hip preservation in osteonecrosis of the femoral head. The study highlights a high hip-preservation rate and introduces the concept of “survival with collapse”, whereby radiographic progression does not equate to functional decline. This commentary emphasizes appropriate patient selection, radiological predictors, and the value of individualized non-surgical strategies in managing osteonecrosis of the femoral head.
