Discussion
hip preservation failure, HPS&FA, necrotic, HPS
NECROTIC
The CRPM demonstrated superior performance compared to both the RPM and CPM. Using CT radiomics, RPM can provide detailed information on the necrotic area of the femoral head. Instead, CPM evaluates the patient's physical condition, lifestyle, and laboratory tests. As a result of combining the benefits of both models and improving prediction accuracy, the CRPM is an improved model for predicting early postoperative efficacy. In contrast to previous research, we incorporated as many clinical markers as possible. Furthermore, to quantitatively differentiate patients, we evaluated the critical value of predictors in order to significantly improve prediction. Simultaneously, the predictive parameters were incorporated into the nomogram for visualization, facilitating clinical application. HPS&FA nomogram not only predicts effectiveness but also guides perioperative care. With better perioperative supervision, surgeons can choose patients for HPS&FA based on preoperative predictions (age, JIC classification, CT imaging). Further, postoperative predictors can be utilized to direct postoperative rehabilitation, such as glucocorticoids or alcohol usage.HPS&FA efficacy was influenced by four clinical predictors included in CRPM. First, glucocorticoids and alcohol use after surgery have been associated with hip preservation failure (CRPM can predict HPS efficacy as well as guide patient screening and personalized perioperative interventions to improve HPS&FA. According to survival analysis and the nomogram, JIC classification, age, and Rad-score are all positively correlated with hip preservation failure. Consequently, those with a high JIC classification, older than 48 years, and a Rad-score 1.309715 should be cautiously included. Once HPS&FA has been performed, the use of glucocorticoids or alcohol and non-weightbearing time influence HPS&FA's effectiveness. The nomogram suggests avoiding glucocorticoids or alcohol and extending non-weightbearing time can increase HPS&FA success. If you need to continue using glucocorticoids or alcohol after surgery, we strongly recommend extending non-weightbearing time to improve HPS&FA success. Through the specific analysis of preoperative and postoperative risk factors and interventions, we can better screen out suitable patients. Furthermore, we can improve HPS&FA success rates with perioperative advance intervention.There are some limitations to our study: (1) It was a single-center, regressive study, with a relatively small number of included cases, and possible errors. Further verification of multicenter, large-sample, and prospective studies is needed; (2) Failure to quantify the same surgical intervention between different surgeons to increase sample size, which might be addressed by standardized surgical technology assessment tools. (3) Since this study was not prospective, patients had been screened prior to surgery, which may have eliminated some risk factors.