Osteonecrosis of the femoral head (ONFH) is a progressive and potentially disabling condition caused by compromised blood supply to the femoral head, leading to bone necrosis and collapse. Early diagnosis is essential to enable joint-preserving interventions and improve patient outcomes. Magnetic resonance imaging (MRI) is currently considered the most sensitive modality for early detection, whereas computed tomography (CT) provides superior assessment of subchondral bone integrity and structural collapse. In recent years, artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL) techniques, has emerged as a promising tool to enhance diagnostic accuracy, automate lesion segmentation, and predict disease progression. This review aims to provide an overview of current AI applications in MRI for ONFH, focusing on early diagnostic, disease staging and classification, volumetric assessment, differential diagnosis and prognostic prediction. A total of 61 articles were initially identified, of which 13 studies (2021-2025) met the inclusion criteria. Results indicate that DL models, particularly convolutional neural networks (CNNs), achieve excellent diagnostic performance, with reported accuracies up to 98.4% and area under the curve (AUC) values reaching 0.98 for early-stage detection. Several models demonstrated performance comparable to or exceeding that of experienced clinicians, particularly in differentiating ONFH from other hip pathologies and in early disease recognition. AI algorithms also showed high accuracy in staging and classification (AUC up to 99.7% in internal validation), as well as in automated segmentation and volumetric assessment (Dice coefficients up to 0.89), enabling objective quantification of necrotic lesions. Furthermore, prognostic models integrating radiomics and ML techniques demonstrated promising results in predicting femoral head collapse (AUC up to 0.85). From a clinical perspective, AI appears to function primarily as a supportive tool, improving diagnostic consistency, efficiency, and reproducibility, and acting as a "second reader" capable of reducing variability among less experienced clinicians. However, significant limitations remain, including dataset heterogeneity, predominance of retrospective and monocentric studies, and limited integration of clinical data. In conclusion, AI-based MRI analysis shows strong potential to enhance the diagnosis, staging, and management of ONFH. Future research should focus on multicenter prospective validation, integration of multimodal clinical data, and development of explainable and generalizable models to facilitate widespread clinical adoption.

Avascular necrosis (AVN) is a musculoskeletal condition characterized by pain, mobility limitations, and functional decline, that may restrict daily participation. This cross-sectional study investigated occupational balance, activity performance and satisfaction, and quality of life in 32 individuals with AVN and 31 healthy controls. Participants completed the Occupational Balance Questionnaire, Canadian Occupational Performance Measure (COPM), and World Health Organization Quality of Life-BREF. Individuals with AVN showed significantly lower occupational balance, COPM performance and satisfaction, and quality of life across general, physical, psychological, social, and total quality of life (p<.001), whereas the environmental domain did not differ. These findings underscore the need for occupation-centered rehabilitation in AVN.

Avascular necrosis (AVN) of the femoral head is a rare but serious cause of hip pain, often presenting with non-specific symptoms that can be mistaken for more common musculoskeletal conditions. We report the case of a 65-year-old Asian male, a retired taxi driver without traditional AVN risk factors, who presented with a three-month history of progressive right hip pain - characterized as a dull, constant ache that sharpened during weight-bearing activities - and associated limping. Clinical examination revealed antalgic gait, restricted hip range of motion, and positive orthopedic tests, prompting imaging that confirmed AVN with subchondral collapse. Conservative management involving manual therapy, joint mobilization, and exercise offered only temporary symptomatic relief, and the patient eventually required total hip replacement. This case underscores the importance of careful assessment, early imaging, and multidisciplinary collaboration in managing persistent hip pain, while also highlighting the need for musculoskeletal clinicians to be vigilant for vascular pathologies and rare conditions such as AVN, particularly in older adults and those with chronic inflammatory disorders.

This article presents an expert consensus on vascular assessment and management strategies for adult femoral neck fractures, based on a narrative review of current evidence and the collective clinical experience of a multidisciplinary panel of orthopaedic and reconstructive surgeons. To assist clinicians in accurately evaluating the vascular status of the femoral head and formulating individualized treatment plans, based on anatomic understanding of its blood supply, current vascular assessment techniques, and the establishment of a novel classification system. The ultimate goal is to reduce postoperative complications and improve patient outcomes. Femoral neck fractures in adults are associated with high rates of avascular necrosis (AVN) and nonunion, largely due to disruption of the femoral head's vascular supply. This expert consensus contains an updated vascular-based classification system and corresponding treatment strategies to improve outcomes in femoral neck fracture management. It integrates anatomic insights into femoral head blood supply, mechanisms of vascular injury, and advanced imaging assessments-especially digital subtraction angiography (DSA)-which may be used to evaluate perfusion status. A novel vascular classification system incorporating CT and DSA findings is proposed to stratify fractures into 4 types based on vascular involvement. Treatment recommendations are made accordingly, ranging from conservative management to internal fixation using bidirectional porous tantalum screws, femoral neck system, or hip arthroplasty. Emphasis is placed on preserving the epiphyseal arterial network by minimizing invasive maneuvers and controlling screw depth. For patients with complete vascular disruption, open reduction combined with microvascular reconstruction and vascularized bone grafting may be considered as an advanced option based on expert consensus. In addition, a scoring system based on patient age, fracture displacement, and vascular injury is proposed to predict complications. This consensus supports a shift from mechanically focused treatment toward a combined biomechanical-biological approach, highlighting the central role of vascular preservation in femoral head-saving strategies.

BACKGROUND Avascular necrosis (AVN) is a disabling musculoskeletal complication of sickle cell disease (SCD), resulting from recurrent vaso-occlusive episodes and chronic microvascular ischemia. Although weight-bearing joints such as the femoral head are most commonly affected, humeral head involvement can lead to significant pain and functional limitation. Management of AVN in SCD remains challenging, and interest has grown in adjunctive therapies such as hyperbaric oxygen therapy (HBOT), which can enhance tissue oxygenation, promote angiogenesis, and support bone remodeling. Evidence regarding its role in non-weight-bearing joints remains limited. CASE REPORT A 32-year-old woman with homozygous SCD (HbSS) presented with a 2-month history of progressive bilateral shoulder pain and restricted motion. Magnetic resonance imaging (MRI) demonstrated stage II pre-collapse AVN of both humeral heads. Baseline laboratory evaluation showed stable chronic anemia consistent with SCD, without evidence of acute infection or inflammatory elevation. Following perioperative exchange transfusion to reduce hemoglobin S concentration, she underwent arthroscopic-assisted core decompression with ipsilateral fibular strut autografting of both shoulders in staged procedures. Postoperatively, she completed 40 sessions of HBOT at 2.5 atmospheres absolute for 60 min each, in addition to oral alendronate 70 mg weekly for 6 months. During clinical follow-up, she reported complete resolution of pain and restoration of full, pain-free range of motion bilaterally. Post-treatment MRI demonstrated preserved articular architecture with improvement in marrow signal. CONCLUSIONS This case report shows that a multimodal joint-preserving approach combining surgical decompression and adjunctive HBOT can be associated with meaningful clinical improvement in early-stage humeral head AVN secondary to SCD. However, as multiple concurrent interventions were employed, the independent contribution of HBOT cannot be determined. Larger studies are required to clarify its adjunctive role.