Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 1: Glucocorticoid-Associated Osteonecrosis

Byung Ho Yoon, Lynne C. Jones, Chung Hwan Chen, Edward Y. Cheng, Quanjun Cui, Wolf Drescher, Wakaba Fukushima, Valerie Gangji, Stuart B. Goodman, Yong Chan Ha, Philippe Hernigou, Marc Hungerford, Richard Iorio, Woo Lam Jo, Vikas Khanduja, Harry Kim, Shin Yoon Kim, Tae Young Kim, Hee Young Lee, Mel S. LeeYoung Kyun Lee, Yun Jong Lee, Michael A. Mont, Takashi Sakai, Nobuhiko Sugano, Masaki Takao, Takuaki Yamamoto, Kyung Hoi Koo

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70 Scopus citations


Background: Glucocorticoid usage, a leading cause of osteonecrosis of the femoral head (ONFH), and its prevalence was reported in 25%-50% of non-traumatic ONFH patients. Nevertheless, there have been no unified criteria to classify glucocorticoid-associated ONFH (GA-ONFH). In 2015, the Association Research Circulation Osseous addressed the issue of developing a classification scheme. Methods: In June 2017, a task force was set up to conduct a Delphi survey concerning ONFH. The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries. Each round of the Delphi survey consists of questionnaires, analysis of replies, and feedback reports to the panel. After 3 rounds of the survey, the panel reached a consensus on the classification criteria. The response rates were 100% (Round 1), 96% (Round 2), and 100% (Round 3), respectively. Results: The consensus on the classification criteria of GA-ONFH included the following: (1) patients should have a history of glucocorticoid use >2 g of prednisolone or its equivalent within a 3-month period; (2) osteonecrosis should be diagnosed within 2 years after glucocorticoid usage, and (3) patients should not have other risk factor(s) besides glucocorticoids. Conclusion: Association Research Circulation Osseous established classification criteria to standardize clinical studies concerning GA-ONFH.

Original languageEnglish
Pages (from-to)163-168.e1
JournalJournal of Arthroplasty
Issue number1
StatePublished - Jan 2019

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Inc.


  • Delphi
  • avascular necrosis
  • corticosteroid
  • femoral head
  • glucocorticoid
  • osteonecrosis


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