Abstract: BACKGROUND: Osteonecrosis of the femoral head is a severe disease that can lead to femoral head collapse and joint degeneration. It is characterized by severe hip pain, often affecting the knee and ipsilateral hip. Surgical intervention remains the primary treatment for advanced-stage osteonecrosis of the femoral head. However, research trends in this field are continuously evolving, and to date, no bibliometric analysis has been conducted to explore the research landscape.  
OBJECTIVE: To provide a comprehensive overview of global research trends, knowledge structures, and emerging hotspots in the surgical treatment of osteonecrosis of the femoral head from 2005 to 2024 through a bibliometric analysis.  
METHODS: Publications related to the surgical treatment of osteonecrosis of the femoral head from September 1, 2005, to September 1, 2024, were retrieved from the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases. VOSviewer, CiteSpace, and the R package “Bibliometrix” were used for the bibliometric analysis.  
RESULTS AND CONCLUSION: (1) After filtering and deduplication of the literature based on specific keywords, 539 relevant publications from the WoSCC database and 1 039 from the CNKI database were included in the bibliometric analysis. (2) In the WoSCC database, China and the United States were the leading countries in publication volume. The overall number of publications showed an upward trend from 2005 to 2024, with peaks in 2016 and 2022. The leading research institutions included Shanghai Jiao Tong University, Sichuan University, the Hospital for Special Surgery (HSS), and Peking University. The most popular journals in this field were J PEDIATR ORTHOP, CLIN ORTHOP RELAT RES, and J ORTHOP SURG RES. J BONE JOINT SURG AM, CLIN ORTHOP RELAT
R, and J BONE JOINT SURG BR were the most frequently cited journals. The publications were authored by 2 498 researchers, with HE WEI, SIEBENROCK, KLAUS A, KLINGELE, KEVIN E, and SUN WEI being the most prolific authors. Articles by MONT MA, LIEBERMAN JR, DELANOIS RE, and MARKER DR had the highest citation counts. The primary topics and emerging research hotspots in osteonecrosis of the femoral head surgical treatment were reflected by keywords such as avascular necrosis, hip, and femoral head. (3) In the CNKI database, the leading institutions were the Department of Orthopedics at Shanghai Jiao Tong University Affiliated Sixth People's Hospital (8 articles), the Department of Orthopedics at Union Hospital of Huazhong University of Science and Technology (7 articles), and the Department of Orthopedics at Wangjing Hospital of China Academy of Chinese Medical Sciences (7 articles). The journals Chinese Journal of Orthopaedic Surgery (36 articles) and Chinese Journal of Bone and Joint Injury (36 articles) had the highest publication volumes. The top three prolific authors were HE WEI (14 articles), CHEN WEIHENG (9 articles), and LIU XINWEI (5 articles). The top five keywords were surgical treatment (49 occurrences), internal fixation (25 occurrences), treatment (23 occurrences), review (22 occurrences), and core decompression (22 occurrences). (4) This is the first bibliometric study to comprehensively summarize the research trends and advancements in the surgical treatment of osteonecrosis of the femoral head. These findings highlight recent research frontiers and emerging hotspots, providing a foundation for academic research and insights for clinical decision-makers.  

Key words: osteonecrosis of the femoral head,  , surgery, bibliometrics, visual analysis, Bibliometrix, research trend, biomaterial