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

• Hines JT
• Jo WL
• Cui Q
• Mont MA
• Koo KH
• Cheng EY
• Goodman SB
• Ha YC
• Hernigou P
• Jones LC
• Kim SY
• Sakai T
• Sugano N
• Yamamoto T
• Lee MS
• Zhao D
• Drescher W
• Kim TY
• Lee YK
• Yoon BH
• Baek SH
• Ando W
• Kim HS
• Park JW

• KMID: 2516767
• DOI: http://doi.org/10.3346/jkms.2021.36.e177

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.

Keyword

Hip; Femoral Head; Osteonecrosis; Avascular Necrosis

Figure

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  Fig. 1 Pathogenesis of non-traumatic osteonecrosis of the femoral head.

• 

  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 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 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.

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