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

• Cui Q
• Jo WL
• Koo KH
• Cheng EY
• Drescher W
• Goodman SB
• Ha YC
• Hernigou P
• Jones LC
• Kim SY
• Lee KS
• Lee MS
• Lee YJ
• Mont MA
• Sugano N
• Taliaferro J
• Yamamoto T
• Zhao D

• KMID: 2513706
• DOI: http://doi.org/10.3346/jkms.2021.36.e65

Abstract

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.

Keyword

Pathogenesis; Osteonecrosis; Osteonecrosis of the Femoral Head

Figure

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  Fig. 1 Pathogenesis of non-traumatic osteonecrosis and transient marrow necrosis.

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  Fig. 2 The marrow space is filled with hypertrophied fat cells. However, osteocytes are seen in lacunae (Arlet and Durroux Type 1 lesion) (hematoxylin and eosin stain, original magnification ×200).

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  Fig. 3 Nuclei of fat cells are not seen and the marrow space is necrotic. However, more than 50% of the lacunae are filled with osteocytes (Arlet and Durroux Type 2 lesion) (hematoxylin and eosin stain, original magnification ×200).

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  Fig. 4 Marrow is necrotic and most lacunae are empty (Arlet and Durroux Type 3 lesion) (hematoxylin and eosin stain, original magnification ×200).

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  Fig. 5 Fibrous encapsulation (arrows) is seen at the peripheral portion of the sequestrum (Arlet and Durroux Type 4 lesion). Subchondral fracture (arrow-heads), which appears as the “crescent” sign on radiograph, is seen (hematoxylin and eosin stain).

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  Fig. 6 Bone trabeculae are thin and lined by osteoblasts. Focal bone resorption is seen at some areas (arrows). However, active osteoclasts are not seen and there is no creeping bone substitution. Marrow space is filled with serosanguinous materials, chronic inflammatory cells, vascular channels, and fibrosis (hematoxylin and eosin, ×100).

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