The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study

Koo, Kyung‐Hoi; Mont, Michael A.; Cui, Quanjun; Hines, Jeremy T.; Yoon, Byung‐Ho; Novicoff, Wendy M.; Lee, Yun Jong; Cheng, Edward Y.; Drescher, Wolf; Hernigou, Philippe; Kim, Shin‐Yoon; Sugano, Nobuhiko; Zhao, Dewei; Ha, Yong‐Chan; Goodman, Stuart B.; Sakai, Takashi; Jones, Lynne C.; Lee, Mel S.; Yamamoto, Takuaki; Lee, Youngkyun; Kang, Yusuhn; Burgess, J.G.; Chen, Dennis; Quinlan, Nicole D.; Xu, Jian; Park, Jung-Wee; Kim, Hong-Seok

doi:10.1016/j.arth.2022.02.009

Cited by 17 publications

(22 citation statements)

References 32 publications

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“…“Crescent sign” was replaced with “subchondral fracture.” Stage 3 was subdivided into early (3A) and late (3B) stage according to depth (less than/equal to or greater than 2 mm) of head depression, and “fracture in necrotic portion” was added to the description of stage 3 10,11 . Subclassification of location and size of the necrotic area was not incorporated into the 2019 revised version 10,11,26 . The revised version mainly focused on analysis of CT image findings, because of the sensitivity to various fracture types, which is important for distinguishing ARCO stages 2 and 3 26 .…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Subclassification of location and size of the necrotic area was not incorporated into the 2019 revised version. 10,11,26 The revised version mainly focused on analysis of CT image findings, because of the sensitivity to various fracture types, which is important for distinguishing ARCO stages 2 and 3. 26 The revised version mentions that fractures in osteonecrosis range from subchondral fracture to fracture in necrotic portion.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,26 The revised version mainly focused on analysis of CT image findings, because of the sensitivity to various fracture types, which is important for distinguishing ARCO stages 2 and 3. 26 The revised version mentions that fractures in osteonecrosis range from subchondral fracture to fracture in necrotic portion. 2,10 Histologic analysis studies of these various fractures are frequent, [27][28][29][30][31] but CT studies are limited.…”

Section: Discussionmentioning

confidence: 99%

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What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

Bae,

Lee,

Kim

et al. 2023

J Comput Assist Tomogr

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The aim of the study is to evaluate the stage 3 findings of the 2019 revision of the Association Research Circulation Osseous (ARCO) staging system for osteonecrosis of the femoral head between 3A and 3B and the relationship with bone resorption area. Materials and Methods:We retrospectively enrolled 87 patients with ARCO stage 3 osteonecrosis of the femoral head, divided into stage 3A (n = 73) and 3B (n = 14). The revised stage 3 findings included subchondral fracture, fracture in necrotic portion, and flattening of the femoral head and were compared between stage 3A and 3B. The association between these findings and the causative features of bone resorption area was also evaluated.Results: All stage 3 cases had subchondral fractures. In stage 3A, these fractures were generated by crescent sign (41.1%) and by fibrovascular reparative zone in 58.9%; however, in stage 3B, fibrovascular reparative zone generated 92.9% of these fractures and crescent sign only 7.1% with statistical significance (P = 0.034). Necrotic portion fracture was noted in 36.7% and femoral head flattening was observed in 14.9% of all stage 3. Necrotic portion fracture (92.9% vs 26.0%) and femoral head flattening (71.4% vs 4.1%) were observed more frequently in stage 3B than 3A (P < 0.001). Almost all subchondral fractures by fibrovascular reparative zone (96.4%) and necrotic portion fracture (96.9%), and all femoral head flattening was presented with bone resorption area with expanding areas. Conclusions:The ARCO stage 3 descriptions reflect severity in this order: subchondral fracture, necrotic portion fracture, and femoral head flattening. More severe findings are usually associated with expanding bone resorption areas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

Bae,

Lee,

Kim

et al. 2023

J Comput Assist Tomogr

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“…The pathogenesis of ONFH is complex, varied, and remains unclear, but commonly accepted causes involve hormone use, alcohol abuse, and trauma [17][18][19] . In this study, the incidence of alcoholic ONFH among female patients was very low.…”

Section: Discussionmentioning

confidence: 99%

Single-centre epidemiological investigation and diagnosis analysis of osteonecrosis of the femoral head

Liu,

Yue,

Guo

et al. 2023

Preprint

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Purpose In this retrospective case investigation, we analysed the data of patients with osteonecrosis of the femoral head (ONFH) in a single centre to reveal demographic and clinical diagnostic features of ONFH and provide a reference for its prevention, diagnosis, and treatment. Methods We collected data from patients in our hospital, focusing on the aetiology and diagnosis of ONFH. Medical records and self-design questionnaires were used to collect information for statistical analysis, including age, aetiology, reason for glucocorticoid use, hospital level at first visit, and diagnosis. Results In total, 203 patients with complete medical records were included in the analysis. The mean patient age was 41.23 ± 12.61 years. The peak age distribution was in the 30s among men and in the 40s among women. Of the total, 100 patients had steroid-induced ONFH (49.26%), 55 had alcoholic ONFH (27.09%), 23 had traumatic ONFH (11.33%), and 25 had idiopathic ONFH (12.32%). Forty-seven patients had intakes of ≥ 2 g prednisone or its equivalent within a 3-month period, and fifty-three patients had a history of low-dose steroid in the past 3 years. Of the total, 112 patients were diagnosed with ONFH at the first visit (diagnosis rate55.17%). The rate of misdiagnosis at all hospital levels was highest for lumbar disc herniation. Conclusions Most patients with ONFH were middle-aged and had steroid-induced ONFH. The misdiagnosis rate of ONFH at the first visit was very high, especially for misdiagnosis of lumbar disc herniation, indicating that the diagnosis of ONFH must be improved.

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“…Osteoarthritic manifestations of the hip, such as narrowing of the joint space, acetabular changes, and destruction, are visible on imaging in ARCO stage IV [ 2 ]. Koo et al [ 3 ] suggested the predictability of femoral head collapse in patients with osteonecrosis, which adds to the spectrum of possibilities for treating patients with intermediate to advanced stage diseases. ONFH is clinically managed by total hip arthroplasty (THA), as conservative treatment and hip preservation therapy are insufficient to satisfy the patients’ needs for daily living.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcomes Following Total Hip Arthroplasty Between Patients Diagnosed with Association Research Circulation Osseous (ARCO) Stage III and Stage IV Osteonecrosis of the Femoral Head: A Retrospective Study of 302 Patients

Yang

Chu

et al. 2023

Med Sci Monit

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Background This retrospective study from a single center aimed to compare outcomes following total hip arthroplasty (THA) in 302 patients diagnosed with Association Research Circulation Osseous (ARCO) stage III and stage IV osteonecrosis of the femoral head (ONFH). Material/Methods The study included 302 patients who underwent THA for ONFH between January 2018 and September 2021. Patient groups included ARCO stage III (n=145) and ARCO stage IV (n=157). Outcomes measured included duration of disease, operative time, intraoperative blood volume, postoperative length of hospital stay, pain measured by the visual analog scale (VAS) score, Harris hip score (HHS), and forgotten joint score (FJS). Results Patients with ARCO stage III ONFH had a significantly shorter operative time ( P =0.009), shorter length of hospital stay ( P =0.021), and reduced volume of intraoperative bleeding ( P =0.021) compared with patients with ARCO stage IV ONFH. There were no significant differences in disease duration ( P =0.310), postoperative complications ( P =0.07), preoperative ( P =0.086, P =0.156) and postoperative ( P =0.062, P =0.173) HHS and VAS scores, respectively. Patients with stage III ONFH reported significantly higher FJS scores at 3 months, 6 months, and 1 year after THA. Conclusions Patients who underwent hip arthroplasty for ARCO stage III femoral head necrosis experienced shorter operative time and hospital stay, less intraoperative bleeding, and better restoration of hip function than those with ARCO stage IV. Moreover, stage III patients were more prone to “forget” their hip arthroplasty experience within 1 year of surgery.

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The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study

Cited by 17 publications

References 32 publications

What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

Single-centre epidemiological investigation and diagnosis analysis of osteonecrosis of the femoral head

Comparison of Outcomes Following Total Hip Arthroplasty Between Patients Diagnosed with Association Research Circulation Osseous (ARCO) Stage III and Stage IV Osteonecrosis of the Femoral Head: A Retrospective Study of 302 Patients

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