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J Arthroplasty. 2019 Jan;34(1):163-168.e1. doi: 10.1016/j.arth.2018.09.005. Epub 2018 Sep 22.

Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 1: Glucocorticoid-Associated Osteonecrosis.

Author information

1
Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea.
2
Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, MD.
3
Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
4
Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN.
5
Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA.
6
Department of Orthopedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany.
7
Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
8
Department of Rheumatology and Physical Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
9
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA.
10
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
11
Department of Orthopaedic Surgery, Hôpital Henri Mondor, Creteil, France.
12
Department of Orthopedic Surgery, Mercy Medical Center, Baltimore, MD.
13
Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY.
14
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
15
Department of Trauma & Orthopaedics, Addenbrooke's Cambridge University Hospitals, Cambridge, UK.
16
Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX.
17
Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
18
Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, South Korea.
19
Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, South Korea.
20
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
21
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
22
Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, South Korea.
23
Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD.
24
Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

Abstract

BACKGROUND:

Glucocorticoid usage, a leading cause of osteonecrosis of the femoral head (ONFH), and its prevalence was reported in 25%-50% of non-traumatic ONFH patients. Nevertheless, there have been no unified criteria to classify glucocorticoid-associated ONFH (GA-ONFH). In 2015, the Association Research Circulation Osseous addressed the issue of developing a classification scheme.

METHODS:

In June 2017, a task force was set up to conduct a Delphi survey concerning ONFH. The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries. Each round of the Delphi survey consists of questionnaires, analysis of replies, and feedback reports to the panel. After 3 rounds of the survey, the panel reached a consensus on the classification criteria. The response rates were 100% (Round 1), 96% (Round 2), and 100% (Round 3), respectively.

RESULTS:

The consensus on the classification criteria of GA-ONFH included the following: (1) patients should have a history of glucocorticoid use >2 g of prednisolone or its equivalent within a 3-month period; (2) osteonecrosis should be diagnosed within 2 years after glucocorticoid usage, and (3) patients should not have other risk factor(s) besides glucocorticoids.

CONCLUSION:

Association Research Circulation Osseous established classification criteria to standardize clinical studies concerning GA-ONFH.

KEYWORDS:

Delphi; avascular necrosis; corticosteroid; femoral head; glucocorticoid; osteonecrosis

PMID:
30348552
DOI:
10.1016/j.arth.2018.09.005

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