Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jun 21;36(24):e177.
doi: 10.3346/jkms.2021.36.e177.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Jeremy T Hines #  1 , Woo Lam Jo #  2 , Quanjun Cui  1 , Michael A Mont  3 , Kyung Hoi Koo  4 , Edward Y Cheng  5 , Stuart B Goodman  6 , Yong Chan Ha  7 , Phillippe Hernigou  8 , Lynne C Jones  9 , Shin Yoon Kim  10 , Takashi Sakai  11 , Nobuhiko Sugano  12 , Takuaki Yamamoto  13 , Mel S Lee  14 , Dewei Zhao  15 , Wolf Drescher  16 , Tae Young Kim  17 , Young Kyun Lee  18 , Byung Ho Yoon  19 , Seung Hoon Baek  10 , Wataru Ando  12 , Hong Seok Kim  18 , Jung Wee Park  18
Affiliations
Review

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Jeremy T Hines et al. J Korean Med Sci. .

Abstract

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Keywords: Avascular Necrosis; Femoral Head; Hip; Osteonecrosis.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Pathogenesis of non-traumatic osteonecrosis of the femoral head.
Fig. 2
Fig. 2. Steinberg classification system of femoral head osteonecrosis. Three subsets: mild (< 15% of articular surface or head affected), moderate (15–30%), and severe (> 30%).
Fig. 3
Fig. 3. Japanese Investigation Committee classification system of femoral head osteonecrosis. Four types: type A lesion < medial 1/3 of the weight-bearing portion; type B lesion < medial 2/3 of the weight-bearing portion; type C1 lesion > medial 2/3 of the weight-bearing portion but not extending laterally to the acetabular edge; and type C2 lesion extending laterally to the acetabular edge.
Fig. 4
Fig. 4. Modified Kerboul classification system of femoral head osteonecrosis. A: necrotic angle in mid-coronal MR image. B: necrotic angle in mid-sagittal MR image. Combined necrotic angle: A + B. Three categories: small lesion (combined necrotic angle ≤ 190°), medium-sized lesion (combined necrotic angle between 190° and 240°), and large lesion (combined necrotic angle ≥ 240°).
MR = magnetic resonance.
See this image and copyright information in PMC

References

    1. Dubois EL, Cozen L. Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA. 1960;174(8):966–971. - PubMed
    1. Freund E. Bilateral aseptic necrosis of the femoral head: problems arising in a compensation case. Ann Surg. 1936;104(1):100–106. - PMC - PubMed
    1. Phemister DB. Changes in bones and joints resulting from interruption of circulation. I. General consideration and changes resulting from injury. Arch Surg. 1940;41(2):436.
    1. Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. 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. - PubMed
    1. Kang JS, Park S, Song JH, Jung YY, Cho MR, Rhyu KH. Prevalence of osteonecrosis of the femoral head: a nationwide epidemiologic analysis in Korea. J Arthroplasty. 2009;24(8):1178–1183. - PubMed