J Korean Med Sci.  2021 Jun;36(24):e177. 10.3346/jkms.2021.36.e177.

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

  • 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, Lenox Hill Hospital, Northwell Health, New York, NY, USA
  • 4Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 5Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
  • 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
  • 8Henri-Mondor Hôspital, Creteil, France
  • 9Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • 10Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
  • 11Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
  • 12Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
  • 13Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
  • 14Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  • 15Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
  • 16Department of Orthopedic Surgery, RWTH University Hospital, Aachen, Germany
  • 17Department of Orthopaedic Surgery, Konkuk University College of Medicine, Seoul, Korea
  • 18Department of Orthopaedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea


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.


Hip; Femoral Head; Osteonecrosis; Avascular Necrosis
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