J Korean Med Sci.  2021 Mar;36(10):e65. 10.3346/jkms.2021.36.e65.

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

  • 1Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
  • 2Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Department of Orthopaedic Surgery, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
  • 4Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
  • 5Department of orthopedic surgery, RWTH University Hospital, Aachen, Germany
  • 6Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
  • 7Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
  • 8Hôpital Henri Mondor, Creteil, France
  • 9Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • 10Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Korea
  • 11Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
  • 12Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  • 13Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
  • 14Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
  • 15Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
  • 16Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
  • 17Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China


Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.


Pathogenesis; Osteonecrosis; Osteonecrosis of the Femoral Head
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