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Practice Guideline

Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults

Microsurgery Department of the Orthopedics Branch of the Chinese Medical Doctor Association et al. Orthop Surg. 2017 Feb.

Abstract

The treatment of adult osteonecrosis of the femoral head (ONFH), with 8.12 million patients in China, remains a challenge to surgeons. To standardize and improve the efficacy of the treatment of ONFH, Chinese specialists updated the experts' suggestions in March 2015, and an experts' consensus was given to provide a current basis for the diagnosis, treatment and evaluation of ONFH. The current guideline provides recommendations for ONFH with respect to epidemiology, etiology, diagnostic criteria, differential diagnosis, staging, treatment, as well as rehabilitation. Risk factors of non-traumatic ONFH include corticosteroid use, alcohol abuse, dysbarism, sickle cell disease and autoimmune disease and others, but the etiology remains unclear. The Association Research Circulation Osseous (ARCO) staging system, including plain radiograph, magnetic resonance imaging, radionuclide examination, and histological findings, is frequently used in staging ONFH. A staging and classification system was proposed by Chinese scholars in recent years. The major differential diagnoses include mid-late term osteoarthritis, transient osteoporosis, and subchondral insufficiency fracture. Management alternatives for ONFH consist of non-operative treatment and operative treatment. Core decompression is currently the most common procedure used in the early stages of ONFH. Vascularized bone grafting is the recommended treatment for ARCO early stage III ONFH. This guideline gives a brief account of principles for selection of treatment for ONFH, and stage, classification, volume of necrosis, joint function, age of the patient, patient occupation, and other factors should be taken into consideration.

Keywords: Diagnosis; Guideline; Osteonecrosis of the femoral head (ONFH); Treatment.

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Figures

Figure 1
Figure 1
Clinical diagnosis flow chart of osteonecrosis of the femoral head (ONFH). ARCO, Association Research Circulation Osseous; CT, computed tomography; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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