Abstract:[Objective] To identify the potential long non-coding RNAs (lncRNAs) and signaling pathways involved in steroid-induced osteonecrosis of femoral head (SONFH), and investigate their molecular mechanisms. [Methods] Microarray data (GSE123568) were down- loaded from NCBI-GEO and analyzed using bioinformatics tools. By analyzing Differentially Expressed Genes (DEG), Kyoto Encyclopedia of Genes and Genomes (KEGG) amplification pathways, Gene Ontology (GO), and finally identified a protein-protein interaction (PPI) net- work and identified 3 key noncoding genes and 1 key mRNA. We further studied the co-expression profiles of mRNAs, miRNAs and ln- cRNAs in SONFH, established a specific competitive endogenous RNA (ceRNA) network for SONFH, analyzed immune infiltration, and ex- plored the relationship between DEG and immune cells, finally verified with GSE26316. [Results] A total of 374 mRNAs were obtained in the microarray, including 258 down-regulated and 116 up-regulated. Seven lncRNAs were obtained, among which C20orf197, MIR22HG and XIST were significantly different (P<0.05). The results of biological process analysis showed that DEG was obviously enriched in in- flammatory response. Molecular function analysis showed that DEG was significantly enriched in ubiquitin- protein transferase activity, ubiquitin- protein ligase binding and receptor activity. Analysis of cell components showed that DEG was mainly enriched in cytoplasm. Genes in PPI network modules were mainly enriched in the structural components of GO,s blood shadow protein-related cytoskeleton, plas- ma membrane and cytoskeleton, while in KEGG, they were mainly enriched in toll-like receptor signaling pathways. Six key genes were identified in this study. By analyzing the immune infiltration, it was found that SONFH tissues contained a higher proportion of CD4 primi- tive T cells (P<0.05), and verified the expression level of FOXO3 in GSE26316 data set. [Conclusion] C20orf197, MIR22HG and XIST are potential markers in the pathogenesis of SONFH, and the gene axis XIST/Has-miR-217/FOXO3 plays an important role in the occurrence and development of SONFH.