Open research questions in Bone and Joint Diseases

What the literature leaves open

• The gap in current practice is that one sequence is often preferred over the other without considering the specific clinical indication. The gap is also that the advantages and disadvantages of each sequence are not well understood. The paper aims to fill this gap by comparing the two sequences and providing a better understanding of their strengths and weaknesses.

  STIR or T2-Dixon? A false dilemma in musculoskeletal MRI · 2026 · DOI

• The clinical benefit of computer-assisted navigation in curved intertrochanteric varus osteotomy is uncertain. Prior studies have not adequately compared the outcomes of navigation-assisted and conventional osteotomy. The study aims to address this gap by evaluating the clinical outcomes of navigation-assisted versus conventional osteotomy.

  Navigation-assisted curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head · 2026 · DOI

• Lack of evidence-informed recommendations for minimally invasive hip preservation techniques in adults with early- to mid-stage nontraumatic ONFH. Limited understanding of the effectiveness of individualized hip-preserving regimens. Need for standardized staging and classification systems for ONFH.

  Chinese clinical practice guidelines for minimally invasive hip preservation techniques for femoral head osteonecrosis (2025 edition) · 2026 · DOI

• The authors note that the management of non-inflammatory nodules after PLLA injections is challenging due to the lack of standardized or evidence-based therapeutic algorithms. The paper highlights the risk of lipoatrophy and secondary infection associated with conventional management options.

  High-Intensity Focused Ultrasound as a Novel Approach for the Management of Non-inflammatory Nodules After Poly-L-Lactic Acid (PLLA) Injections · 2026 · DOI

• There is a need to evaluate the complication profile associated with THA in different patient populations. The study aims to fill the gap in knowledge about the outcomes of THA in patients with cirrhosis. The study identifies the lack of understanding about the specific perioperative risks and outcomes associated with varying degrees of liver disease severity.

  Comparing outcomes of total hip arthroplasty between cirrhotic and non-cirrhotic patients through a propensity-matched analysis · 2026 · DOI

• The novel nature of the intervention and the lack of established efficacy data make it difficult to design a controlled trial. Ethical considerations regarding withholding a potentially beneficial joint-preserving treatment from younger patients at risk of femoral head collapse also pose a challenge.

  Arthroscopy-Assisted Core Decompression Combined with Octacalcium Phosphate/Gelatin Composite Implantation for Osteonecrosis of the Femoral Head: A Study Protocol for a Single-Center Externally Controlled Trial · 2026 · DOI

• There is a lack of comparative data on diagnostic work-up, multidisciplinary management, and follow-up of pregnancy-related transient osteoporosis of the hip. The condition is often underdiagnosed due to nonspecific clinical presentation.

  Bilateral Transient Osteoporosis of the Hip in Pregnancy: Diagnostic Challenges, MRI-Based Approach, and Multidisciplinary Management · 2026 · DOI

• Limited understanding of the mechanical properties of different zones in osteonecrosis. Lack of characterization of the viscoelastic behavior of trabecular bone cores. Need for investigation of the failure modes of cylindrical cores extracted from different zones.

  Multiscale mechano-biological characterization of necrotic, sclerotic, and healthy zones in femoral head osteonecrosis: linking viscoelastic heterogeneity to mechanical failure · 2026 · DOI

• The lack of consensus in definitions and diagnostic criteria is a significant gap. The paper identifies the need for further research to establish standardized diagnostic criteria. The ambiguity in terminology is a major challenge in understanding and treating these conditions.

  A Rose by Any Other Name? Terminology and Ambiguity in Pregnancy- and Lactation-Associated Osteoporosis, Transient Osteoporosis of the Hip, and Bone Marrow Edema Syndrome · 2026 · DOI

• The precise mechanisms underlying femoral head osteonecrosis in LCPD remain incompletely understood. There is a need for a comprehensive review of the literature to identify gaps and inconsistencies in our understanding of LCPD. The current literature is limited by methodological heterogeneity, small study populations, and limited functional validation.

  A Proposed Convergent Genetic and Molecular Framework for Legg–Calvé–Perthes Disease: A Scoping Review · 2026 · DOI

• Glucocorticoids-induced osteonecrosis of the femoral head (GONFH) is characterized by progressive cartilage degeneration, yet the role of calcified cartilage zone (CCZ) remodeling in this process remains poorly understood.

  Calcified Cartilage Zone Remodeling Induced by IL-1β Derived from Necrotic Subchondral Bone Initiates Cartilage Degeneration in Patients with Glucocorticoids-induced Osteonecrosis of the Femoral Head · 2025 · DOI

• The incidence of steroid-induced osteonecrosis of the femoral head (SONFH) is increasing annually; however, the underlying pathological mechanism remains unclear, which is an obstacle to its effective treatment.

  Injectable hydrogel regulates immune infiltration through physical and chemical synergy in the treatment of steroid-induced osteonecrosis of the femoral head · 2025 · DOI

• In such cases, hemiarthroplasty or total shoulder arthroplasty (TSA) is typically indicated, although long-term outcomes in younger patients remain uncertain.

  Costal osteochondral autograft for osteonecrosis of the humeral head: a case report · 2025 · DOI

• However, the potential molecular targets for pharmacologic treatment of non-traumatic osteonecrosis remain underexplored.

  Potential molecular targets for the pharmacologic management of non-traumatic osteonecrosis · 2024 · DOI

• Future studies combining administrative databases with imaging findings and patient-reported outcomes are warranted to establish more precise, age- and stage-specific treatment algorithms for ONFH.

  Shifting surgical strategies for osteonecrosis of the femoral head: evidence from a nationwide Japanese database · 2026 · DOI

• Non-traumatic osteonecrosis of the femoral head (NONFH) is a disabling disease mainly caused by glucocorticoid use and alcohol abuse, characterized by local impairment of blood supply and limited bone repair; however, the composition and regulatory mechanisms of specialized endothelial cells (ECs) in its microenvironment remain unclear.

  Single-cell RNA sequencing analysis reveals the evolution and regulatory features of specialized endothelial cell subsets in non-traumatic osteonecrosis of the femoral head · 2026 · DOI

• Further controlled studies are required to confirm the efficacy of the treatment. Studies are required to determine the individual effect of each component of the treatment.

  “Full moon-like” imaging appearance of the femoral head bone marrow edema treated with mini-open core decompression combined with platelet-rich plasma: A technical report · 2026 · DOI

• There is a lack of studies on the treatment of extensive or persistent hip BME. The individual effect of each component of the treatment is unknown.

  “Full moon-like” imaging appearance of the femoral head bone marrow edema treated with mini-open core decompression combined with platelet-rich plasma: A technical report · 2026 · DOI

• Methodological heterogeneity and small study populations limit the interpretation of the results. Limited functional validation of the identified genetic and molecular factors. The complexity of the disease pathogenesis, involving multiple genetic, epigenetic, vascular, and inflammatory mechanisms.

  A Proposed Convergent Genetic and Molecular Framework for Legg–Calvé–Perthes Disease: A Scoping Review · 2026 · DOI

• Initial ultrasound, laboratory work-up, and rheumatological screening were inconclusive, and intra-articular corticosteroid injections failed to relieve symptoms and were temporally associated with deterioration of glycaemic control and a periorbital and palmar eczematous rash.

  Bilateral Transient Osteoporosis of the Hip in Pregnancy: Diagnostic Challenges, MRI-Based Approach, and Multidisciplinary Management · 2026 · DOI

• Technical complexity, - Demanding rehabilitation, - The widespread success of THA has limited their global adoption, - Assessment of the anterior extent of the necrotic lesion may further refine patient selection and prognostic evaluation for curved varus…

  Femoral osteotomies for hip joint preservation · 2026 · DOI

• Continued technological innovation, - Effective transmission of surgical expertise, - Further development of this contribution to hip-preserving surgery, - Assessment of the anterior extent of the necrotic…

  Femoral osteotomies for hip joint preservation · 2026 · DOI

• Investigate the long-term effects of navigation-assisted CVO, - Compare navigation-assisted CVO with other joint-preserving procedures, - Examine the cost-effectiveness of navigation-assisted…

  Navigation-assisted curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head · 2026 · DOI

• Prospective studies are needed to confirm efficacy, - Standardized treatment protocols need to be established, - Further research is needed to understand the biological rationale for the observed efficacy…

  High-Intensity Focused Ultrasound as a Novel Approach for the Management of Non-inflammatory Nodules After Poly-L-Lactic Acid (PLLA) Injections · 2026 · DOI

• Future research should focus on developing prospective studies with larger cohorts of particularly moderate-to-severe cirrhotic patients, - Further research is needed to delineate the specific perioperative risks and outcomes associated with varying degrees of liver disease…

  Comparing outcomes of total hip arthroplasty between cirrhotic and non-cirrhotic patients through a propensity-matched analysis · 2026 · DOI

Most-cited papers in Bone and Joint Diseases

• Targeting ferroptosis suppresses osteocyte glucolipotoxicity and alleviates diabetic osteoporosis · Bone Research · 2022 · 256 citations
• Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle · The American Journal of Sports Medicine · 2007 · 238 citations
• The physiopathology of avascular necrosis of the femoral head: an update · Injury · 2016 · 126 citations
• Ischemia and Necrosis of Bone · Military Medicine · 1981 · 110 citations
• Long bone non-unions treated with the diamond concept: a case series of 64 patients · Injury · 2015 · 105 citations
• Donor site morbidity after bone harvesting from the anterior iliac crest · Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology · 2009 · 105 citations
• MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost · Wiener klinische Wochenschrift · 2005 · 98 citations
• Donor site morbidity of the anterior iliac crest following cancellous bone harvest · International Journal of Oral and Maxillofacial Surgery · 1996 · 95 citations
• Application of bone morphogenetic proteins to femoral non-unions: A 4-year multicentre experience · Injury · 2009 · 87 citations
• Avascular necrosis of bone caused by combination chemotherapy without corticosteroids. · BMJ · 1984 · 83 citations

Most recent work

• Navigation-assisted transtrochanteric rotational osteotomy for osteonecrosis of the femoral head · International Orthopaedics · 2026
• Osteonecrosis of the Femoral Head: A Dysbiotic Condition? · The Journal of Arthroplasty · 2026
• Bilateral curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head: a retrospective comparative study · International Orthopaedics · 2026
• Comparable clinical outcomes but increased technical difficulty after total hip arthroplasty following curved intertrochanteric varus osteotomy · International Orthopaedics · 2026
• Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline · The Journal of Arthroplasty · 2026
• Roburic acid inhibits glucocorticoid-induced osteonecrosis of the femoral head associated osteoclast activity via targeting PTP1B · Phytomedicine · 2026
• ESR Essentials: bone marrow MRI in oncology—practice recommendations by the European Society of Musculoskeletal Radiology · European Radiology · 2026
• Navigation-assisted curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head · International Orthopaedics · 2026
• Timing of first-time dislocation varied by head size after total hip arthroplasty for nontraumatic osteonecrosis · International Orthopaedics · 2026
• Nuciferine ameliorates steroid-induced osteonecrosis of the femoral head by inhibiting BMSCs ferroptosis via HIF-1α · Phytomedicine · 2026

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