Expert consensus on clinical diagnosis and treatment technique of osteonecrosis of the femoral head (2022 version)_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 Association Related to Circulation Osseous, Chinese Microcirculation Society (CSM-ARCO) , ,

Corresponding author：

Association Related to Circulation Osseous, Chinese Microcirculation Society (CSM-ARCO), Email: sunwei@zryhyy.com.cn

Keywords：

Osteonecrosis of the femoral head; diagnosis; treatment technique; expert consensus

DOI：

10.7507/1002-1892.202207134

Video：

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Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in the clinic. Although the exact pathophysiological mechanism is not fully understood, it is believed to be closely related to the interruption of intra-bone circulation and eventual bone tissue death. The prevention and treatment of ONFH is always a great challenge for orthopedists. The diagnostic level of ONFH has been continuously improved with the development of imaging techniques such as MRI and the in-depth understanding of the disease in recent years.There are many treatment methods for ONFH, which are generally considered individually and comprehensively according to factors such as the patient’s age, osteonecrosis stage, classification, and compliance with joint-sparing treatment. There is currently no unified standard. ONFH staging and classification play an important reference value for doctors to choose treatment options. In recent years, based on the characteristics of ONFH in Chinese people, the academic community has proposed Chinese staging and China-Japan Friendship Hospital (CJFH) classification. The consensus also introduces them together with the international Association Research Circulation Osseous (ARCO) staging to provide guidance for individualized treatment of ONFH. In order to further standardize the diagnosis of ONFH and expand the treatment of ONFH, the Association Related to Circulation Osseous, Chinese Microcirculation Society (CSM-ARCO) organized domestic experts in the field of ONFH to jointly formulate the expert consensus, in order to provide reference for the standardized diagnosis of ONFH and the selection of individualized diagnosis and treatment techniques.

Citation： Association Related to Circulation Osseous, Chinese Microcirculation Society (CSM-ARCO). Expert consensus on clinical diagnosis and treatment technique of osteonecrosis of the femoral head (2022 version). Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1319-1326. doi: 10.7507/1002-1892.202207134 Copy

1.	赵建平, 胡轶, 杜荣辉, 等. 新型冠状病毒肺炎糖皮质激素使用的建议. 中华结核和呼吸杂志, 2020, 43(3): 183-184.
2.	Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest, 2006, 129(6): 1441-1452.
3.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: Results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
4.	Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev, 2019, 4(3): 85-97.
5.	Larson E, Jones LC, Goodman SB, et al. Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018? Int Orthop, 2018, 42(7): 1723-1728.
6.	Mont MA, Salem HS, Piuzzi NS, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today?: A 5-year update. J Bone Joint Surg (Am), 2020, 102(12): 1084-1099.
7.	Motomura G, Yamamoto T, Karasuyama K, et al. Bone SPECT/CT of femoral head subchondral insufficiency fracture. Clin Nucl Med, 2015, 40(9): 752-754.
8.	Zhao D, Zhang F, Wang B, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat, 2020, 21: 100-110.
9.	Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
10.	李子荣. 股骨头坏死临床诊疗规范. 中华骨与关节外科杂志, 2015, 8(1): 1-6.
11.	Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
12.	Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
13.	Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14.	孙伟, 李子荣. 2019国际骨循环研究协会股骨头坏死分期. 中华骨科杂志, 2020, 40(13): 889-892.
15.	Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16.	李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
17.	高福强, 孙伟, 邢更彦. 解读国际医学冲击波学会最新诊疗共识——体外冲击波的适应证与禁忌证. 中华医学杂志, 2017, 97(31): 2411-2415.
18.	孙伟, 李子荣. 体外震波治疗股骨头坏死: 误区与挑战. 中国修复重建外科杂志, 2019, 33(6): 659-661.
19.	张庆熙, 孙伟, 高福强, 等. 体外冲击波治疗股骨头坏死的临床研究进展. 实用骨科杂志, 2015, 21(8): 714-717.
20.	Atilla B, Bakırcıoğlu S, Shope AJ, et al. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev, 2020, 4(12): 647-658.
21.	Kang JS, Suh YJ, Moon KH, et al. Clinical efficiency of bone marrow mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther, 2018, 9(1): 274. doi: 10.1186/s13287-018-1030-y.
22.	Zhao DW, Yu XB. Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res, 2015, 194(2): 614-621.
23.	Zhang Q, Yang F, Chen Y, et al. Chinese herbal medicine formulas as adjuvant therapy for osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(36): e12196. doi: 10.1097/MD.0000000000012196.
24.	孙伟, 刘立华, 高福强, 等. 髓芯减压联合自体骨髓单核细胞移植治疗股骨头坏死失败病例分析. 中华损伤与修复杂志 (电子版), 2020, 15(2): 110-114.
25.	Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.
26.	Sun W, Li Z, Gao F, et al. Recombinant human bone morphogenetic protein-2 in debridement and impacted bone graft for the treatment of femoral head osteonecrosis. PLoS One, 2014, 9(6): e100424. doi: 10.1371/journal.pone.0100424.
27.	Xie H, Wang B, Tian S, et al. Retrospective long-term follow-up survival analysis of the management of osteonecrosis of the femoral head with pedicled vascularized iliac bone graft transfer. J Arthroplasty, 2019, 34(8): 1585-1592.
28.	Osawa Y, Seki T, Morita D, et al. Total hip arthroplasty after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A mean 10-year follow-up. J Arthroplasty, 2017, 32(10): 3088-3092.
29.	Liu LH, Li ZR, Sun W, et al. Reliability and repeatability of the China-Japan friendship hospital typing classification for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2022, 104(Suppl 2): 40-46.
30.	Steinberg ME, Larcom PG, Strafford B, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res, 2001, (386): 71-78.
31.	Hungerford DS, Jones LC. Asymptomatic osteonecrosis: should it be treated? Clin Orthop Relat Res, 2004, (429): 124-130.
32.	Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.

1. 赵建平, 胡轶, 杜荣辉, 等. 新型冠状病毒肺炎糖皮质激素使用的建议. 中华结核和呼吸杂志, 2020, 43(3): 183-184.
2. Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest, 2006, 129(6): 1441-1452.
3. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: Results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
4. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev, 2019, 4(3): 85-97.
5. Larson E, Jones LC, Goodman SB, et al. Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018? Int Orthop, 2018, 42(7): 1723-1728.
6. Mont MA, Salem HS, Piuzzi NS, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today?: A 5-year update. J Bone Joint Surg (Am), 2020, 102(12): 1084-1099.
7. Motomura G, Yamamoto T, Karasuyama K, et al. Bone SPECT/CT of femoral head subchondral insufficiency fracture. Clin Nucl Med, 2015, 40(9): 752-754.
8. Zhao D, Zhang F, Wang B, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat, 2020, 21: 100-110.
9. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
10. 李子荣. 股骨头坏死临床诊疗规范. 中华骨与关节外科杂志, 2015, 8(1): 1-6.
11. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
12. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
13. Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14. 孙伟, 李子荣. 2019国际骨循环研究协会股骨头坏死分期. 中华骨科杂志, 2020, 40(13): 889-892.
15. Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16. 李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
17. 高福强, 孙伟, 邢更彦. 解读国际医学冲击波学会最新诊疗共识——体外冲击波的适应证与禁忌证. 中华医学杂志, 2017, 97(31): 2411-2415.
18. 孙伟, 李子荣. 体外震波治疗股骨头坏死: 误区与挑战. 中国修复重建外科杂志, 2019, 33(6): 659-661.
19. 张庆熙, 孙伟, 高福强, 等. 体外冲击波治疗股骨头坏死的临床研究进展. 实用骨科杂志, 2015, 21(8): 714-717.
20. Atilla B, Bakırcıoğlu S, Shope AJ, et al. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev, 2020, 4(12): 647-658.
21. Kang JS, Suh YJ, Moon KH, et al. Clinical efficiency of bone marrow mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther, 2018, 9(1): 274. doi: 10.1186/s13287-018-1030-y.
22. Zhao DW, Yu XB. Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res, 2015, 194(2): 614-621.
23. Zhang Q, Yang F, Chen Y, et al. Chinese herbal medicine formulas as adjuvant therapy for osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(36): e12196. doi: 10.1097/MD.0000000000012196.
24. 孙伟, 刘立华, 高福强, 等. 髓芯减压联合自体骨髓单核细胞移植治疗股骨头坏死失败病例分析. 中华损伤与修复杂志 (电子版), 2020, 15(2): 110-114.
25. Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.
26. Sun W, Li Z, Gao F, et al. Recombinant human bone morphogenetic protein-2 in debridement and impacted bone graft for the treatment of femoral head osteonecrosis. PLoS One, 2014, 9(6): e100424. doi: 10.1371/journal.pone.0100424.
27. Xie H, Wang B, Tian S, et al. Retrospective long-term follow-up survival analysis of the management of osteonecrosis of the femoral head with pedicled vascularized iliac bone graft transfer. J Arthroplasty, 2019, 34(8): 1585-1592.
28. Osawa Y, Seki T, Morita D, et al. Total hip arthroplasty after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A mean 10-year follow-up. J Arthroplasty, 2017, 32(10): 3088-3092.
29. Liu LH, Li ZR, Sun W, et al. Reliability and repeatability of the China-Japan friendship hospital typing classification for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2022, 104(Suppl 2): 40-46.
30. Steinberg ME, Larcom PG, Strafford B, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res, 2001, (386): 71-78.
31. Hungerford DS, Jones LC. Asymptomatic osteonecrosis: should it be treated? Clin Orthop Relat Res, 2004, (429): 124-130.
32. Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.

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