Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, Goodman SB, Hernigou P, Cui Q, Lineaweaver WC, Xu J, Drescher WR, Qin L, et al.
Journal of orthopaedic translation. Date of publication 2020 Jan 6;volume 21():100-110.
1. J Orthop Translat. 2020 Jan 6;21:100-110. doi: 10.1016/j.jot.2019.12.004.
eCollection 2020 Mar.
Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral
head in adults (2019 version).
Zhao D(1), Zhang F(2), Wang B(1), Liu B(1), Li L(1), Kim SY(3), Goodman SB(4),
Hernigou P(5), Cui Q(6), Lineaweaver WC(2), Xu J(7), Drescher WR(8), Qin L(9).
Author information:
(1)Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian
University, Dalian, PR China.
(2)JMS Burn and Reconstructive Center, Jackson, MS, USA.
(3)Department of Orthopaedic Surgery, Kyungpook National University Hospital,
Daegu, South Korea.
(4)Department of Orthopaedic Surgery and (by Courtesy) Bioengineering, Stanford
University Medical Center Outpatient Center, Redwood City, CA, 94063, USA.
(5)Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital
Henri Mondor, Creteil, France.
(6)Department of Orthopaedic Surgery, University of Virginia School of Medicine,
Virginia, 22903, USA.
(7)School of Pathology and Laboratory Medicine, The University of Western
Australia, Perth, Western Australia, 6009, Australia.
(8)Department of Orthopaedic Surgery of the Lower Limb and Arthroplasty,
Rummelsberg Hospital, D-90592, Schwarzenbruck, Germany.
(9)Musculoskeletal Research Laboratory, Department of Orthopedics &
Traumatology, The Chinese University of Hong Kong, PR China.
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in
orthopaedic clinics. The number of patients with ONFH is increasing worldwide
every year. There are an estimated 8.12 million patients with nontraumatic
osteonecrosis in China alone. Treatment of nontraumatic osteonecrosis has always
been a clinical challenge for orthopaedic surgeons. To further standardize
diagnosis and treatment of ONFH, these guidelines provide not only basic
diagnosis, treatment, and evaluation systems for ONFH but also expert advice and
standards in many aspects, including epidemiology, aetiology, diagnostic
criteria, pathological staging, prevention and treatment options, and
postoperative rehabilitation. The aetiological factors of ONFH can currently be
divided into two major categories: traumatic and nontraumatic; however, the
specific pathological mechanism of ONFH is not completely clear. Currently, the
staging system of ONFH formulated by the Association Research Circulation
Osseous is widely used in clinical practice. Based on the changes in the
intraosseous blood supply at different stages, the corresponding nonsurgical and
surgical treatments are recommended, and when there are risk factors for
possible ONFH, certain preventive measures to avoid the occurrence of
osteonecrosis are recommended. These guidelines provide brief classification
criteria and treatment regimen for osteonecrosis. Specification of the
aetiology, treatment plan based on comprehensive consideration of the different
stages of osteonecrosis, hip function, age, and occupation of the patients are
important steps in diagnosis and developing treatment strategies.
TRANSLATIONAL POTENTIAL OF THIS ARTICLE: New advances in the epidemiology,
etiology, pathophysiology, imaging, diagnosis and treatment of ONFH have been
renewed in this revision. This guideline can be used for reference by orthopedic
professionals and researchers, and for standardized diagnosis and treatment
management under the clinical guidance, which is conducive to the prevention,
treatment and further research of ONFH, improving the diagnosis and treatment
level, making patients' symptoms under good control, and improving their quality
of life.
© 2019 The Author(s).
DOI: 10.1016/j.jot.2019.12.004
PMCID: PMC7152793
PMID: 32309135
Conflict of interest statement: The authors have no conflicts of interest to
disclose in relation to this article.
