This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the benefits and harms of surgical, non-surgical, and pharmacological interventions for paediatric primary lower limb avascular necrosis (AVN). This is a common review protocol, outlining the approach for four separate Cochrane reviews for paediatric primary lower limb AVN. To assess the benefit and harm of surgical interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the benefit and harm of non-surgical interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the benefit and harm of pharmacological interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the comparative effectiveness of surgical, non-surgical, and pharmacological interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. The secondary objective for all four of the reviews is to evaluate health equity by assessing the effects across different geographical regions, gender, and age groups.

Avascular necrosis is a condition that results from disruption of the blood supply to bone. It can develop idiopathically or secondary to disease or corticosteroid use. To facilitate consistent clinical and research practice, this review aimed to identify methods used to assess, diagnose, and determine outcomes of non-femoral head (non-FH) lower limb avascular necrosis in children and adolescents. We conducted a scoping review up to January 2024, searching Ovid Medline, Embase, CINAHL, and Scopus databases. Studies were included if they had 10 or more individuals aged 0-17 yr with non-FH lower limb avascular necrosis, and included assessment, diagnostic criteria, or outcome measures. Measures identified were grouped according to the International Classification of Functioning, Disability, and Health framework of impairments of body function and structure, activity limitations, and participation restrictions. Following full-text screening, 31 studies met the inclusion criteria: 24 of these studies were retrospective (77%). Twenty-three studies involved secondary avascular necrosis (74%) and 8 studies involved primary avascular necrosis (26%). MRI and radiographs were most frequently used for diagnosis. Impairments were predominantly assessed via patient report, and use of validated measures was limited. There was also limited consideration of activity limitations and participation restrictions in both assessment and outcome measures. Where present, these were patient reported. The findings highlight a strong focus on impairments despite a need to consider the conditions impact on activity limitations and participation restrictions. Obtaining consensus on assessments and outcome measures, with increased use of validated measures to improve rigor, would facilitate collation of results in future research.

Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes of shoulder arthroplasty in young patients with PANHH. One hundred and twenty-seven patients aged under 60 years old and suffering from PANHH were operated with arthroplasty. Patients were assessed clinically and radiographically before surgery with a minimum of 2 years of follow up (FU). HA was performed on 108 patients (85%). Two patients were revised for painful glenoid wear after 2 and 4 years. TSA was performed on 19 patients (15%). Five TSA had to be revised for glenoid loosening (n = 4) or instability (n = 1). Revision rate was 26% with TSA and 2% with HA. There were no significant differences between HA and TSA in terms of clinical outcomes. With a mean FU of 8 years, HA and TSA improved clinical outcomes of patients with PANHH. HA revisions for painful glenoid wear were rare (2%). The revision rate was excessively high with TSA (26%).