Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-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

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Background: Although alcohol is a leading risk factor for osteonecrosis of the femoral head (ONFH) and its prevalence reportedly ranges from 20% to 45%, there are no unified classification criteria for this subpopulation. In 2015, Association Research Circulation Osseous decided to develop classification criteria for alcohol-associated ONFH. Methods: In June of 2017, Association Research Circulation Osseous formed a task force to conduct a Delphi survey. The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries. Each round of the Delphi survey included questionnaires, analysis of replies, and feedback reports to the panel. After 3 rounds of the survey, consensus was reached on the classification criteria. The response rates for the 3 Delphi rounds were 100% (round 1), 96% (round 2), and 100% (round 3). Results: The consensus on the classification criteria of alcohol-associated ONFH included the following: (1) patients should have a history of alcohol intake >400 mL/wk (320 g/wk, any type of alcoholic beverage) of pure ethanol for more than 6 months; (2) ONFH should be diagnosed within 1 year after alcohol intake of this dose; and (3) patients should not have other risk factor(s). Conclusion: ARCO-established classification criteria to standardize clinical studies concerning AA-ONFH.

Original languageEnglish
Pages (from-to)169-174.e1
JournalJournal of Arthroplasty
Issue number1
StatePublished - Jan 2019

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Inc.


  • Delphi
  • alcohol
  • avascular necrosis
  • femoral head
  • hip
  • osteonecrosis


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