The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head

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

doi:10.1016/j.arth.2019.11.029

The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head

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

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Abstract

Background: The Association Research Circulation Osseous (ARCO) presents the 2019 revised staging system of osteonecrosis of the femoral head (ONFH) based on the 1994 ARCO classification. Methods: In October 2018, ARCO established a task force to revise the staging system of ONFH. The task force involved 29 experts who used a web-based survey for international collaboration. Content validity ratios for each answer were calculated to identify the levels of agreement. For the rating queries, a consensus was defined when more than 70% of the panel members scored a 4 or 5 rating on a 5-point scale. Results: Response rates were 93.1%-100%, and through the 4-round Delphi study, the 1994 ARCO classification for ONFH was successfully revised. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. This revised staging system does not incorporate the previous subclassification or quantitation parameters, but the panels agreed on the future development of a separate grading system for predicting disease progression. Conclusion: A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. ARCO approved and recommends this revised system as a universal staging of ONFH.

Original language	English (US)
Pages (from-to)	933-940
Number of pages	8
Journal	Journal of Arthroplasty
Volume	35
Issue number	4
DOIs	https://doi.org/10.1016/j.arth.2019.11.029
State	Published - Apr 2020
Externally published	Yes

Keywords

Delphi
avascular necrosis
hip
osteonecrosis
staging

ASJC Scopus subject areas

Orthopedics and Sports Medicine

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10.1016/j.arth.2019.11.029

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Yoon, B. H., Mont, M. A., Koo, K. H., Chen, C. H., Cheng, E. Y., Cui, Q., Drescher, W., Gangji, V., Goodman, S. B., Ha, Y. C., Hernigou, P., Hungerford, M. W., Iorio, R., Jo, W. L., Jones, L. C., Khanduja, V., Kim, H. K. W., Kim, S. Y., Kim, T. Y., ... Zhao, D. W. (2020). The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. Journal of Arthroplasty, 35(4), 933-940. https://doi.org/10.1016/j.arth.2019.11.029

Yoon, BH, Mont, MA, Koo, KH, Chen, CH, Cheng, EY, Cui, Q, Drescher, W, Gangji, V, Goodman, SB, Ha, YC, Hernigou, P, Hungerford, MW, Iorio, R, Jo, WL, Jones, LC, Khanduja, V, Kim, HKW, Kim, SY, Kim, TY, Lee, HY, Lee, MS, Lee, YK, Lee, YJ, Nakamura, J, Parvizi, J, Sakai, T, Sugano, N, Takao, M, Yamamoto, T & Zhao, DW 2020, 'The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head', Journal of Arthroplasty, vol. 35, no. 4, pp. 933-940. https://doi.org/10.1016/j.arth.2019.11.029

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title = "The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head",

abstract = "Background: The Association Research Circulation Osseous (ARCO) presents the 2019 revised staging system of osteonecrosis of the femoral head (ONFH) based on the 1994 ARCO classification. Methods: In October 2018, ARCO established a task force to revise the staging system of ONFH. The task force involved 29 experts who used a web-based survey for international collaboration. Content validity ratios for each answer were calculated to identify the levels of agreement. For the rating queries, a consensus was defined when more than 70% of the panel members scored a 4 or 5 rating on a 5-point scale. Results: Response rates were 93.1%-100%, and through the 4-round Delphi study, the 1994 ARCO classification for ONFH was successfully revised. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. This revised staging system does not incorporate the previous subclassification or quantitation parameters, but the panels agreed on the future development of a separate grading system for predicting disease progression. Conclusion: A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. ARCO approved and recommends this revised system as a universal staging of ONFH.",

keywords = "Delphi, avascular necrosis, hip, osteonecrosis, staging",

author = "Yoon, {Byung Ho} and Mont, {Michael A.} and Koo, {Kyung Hoi} and Chen, {Chung Hwan} and Cheng, {Edward Y.} and Quanjun Cui and Wolf Drescher and Valerie Gangji and Goodman, {Stuart B.} and Ha, {Yong Chan} and Philippe Hernigou and Hungerford, {Marc W.} and Richard Iorio and Jo, {Woo Lam} and Jones, {Lynne C.} and Vikas Khanduja and Kim, {Harry K.W.} and Kim, {Shin Yoon} and Kim, {Tae Young} and Lee, {Hee Young} and Lee, {Mel S.} and Lee, {Young Kyun} and Lee, {Yun Jong} and Junichi Nakamura and Javad Parvizi and Takashi Sakai and Nobuhiko Sugano and Masaki Takao and Takuaki Yamamoto and Zhao, {De Wei}",

note = "Publisher Copyright: {\textcopyright} 2019",

year = "2020",

month = apr,

doi = "10.1016/j.arth.2019.11.029",

language = "English (US)",

volume = "35",

pages = "933--940",

journal = "Journal of Arthroplasty",

issn = "0883-5403",

publisher = "Churchill Livingstone",

number = "4",

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T1 - The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head

AU - Yoon, Byung Ho

AU - Mont, Michael A.

AU - Koo, Kyung Hoi

AU - Chen, Chung Hwan

AU - Cheng, Edward Y.

AU - Cui, Quanjun

AU - Drescher, Wolf

AU - Gangji, Valerie

AU - Goodman, Stuart B.

AU - Ha, Yong Chan

AU - Hernigou, Philippe

AU - Hungerford, Marc W.

AU - Iorio, Richard

AU - Jo, Woo Lam

AU - Jones, Lynne C.

AU - Khanduja, Vikas

AU - Kim, Harry K.W.

AU - Kim, Shin Yoon

AU - Kim, Tae Young

AU - Lee, Hee Young

AU - Lee, Mel S.

AU - Lee, Young Kyun

AU - Lee, Yun Jong

AU - Nakamura, Junichi

AU - Parvizi, Javad

AU - Sakai, Takashi

AU - Sugano, Nobuhiko

AU - Takao, Masaki

AU - Yamamoto, Takuaki

AU - Zhao, De Wei

PY - 2020/4

Y1 - 2020/4

N2 - Background: The Association Research Circulation Osseous (ARCO) presents the 2019 revised staging system of osteonecrosis of the femoral head (ONFH) based on the 1994 ARCO classification. Methods: In October 2018, ARCO established a task force to revise the staging system of ONFH. The task force involved 29 experts who used a web-based survey for international collaboration. Content validity ratios for each answer were calculated to identify the levels of agreement. For the rating queries, a consensus was defined when more than 70% of the panel members scored a 4 or 5 rating on a 5-point scale. Results: Response rates were 93.1%-100%, and through the 4-round Delphi study, the 1994 ARCO classification for ONFH was successfully revised. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. This revised staging system does not incorporate the previous subclassification or quantitation parameters, but the panels agreed on the future development of a separate grading system for predicting disease progression. Conclusion: A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. ARCO approved and recommends this revised system as a universal staging of ONFH.

AB - Background: The Association Research Circulation Osseous (ARCO) presents the 2019 revised staging system of osteonecrosis of the femoral head (ONFH) based on the 1994 ARCO classification. Methods: In October 2018, ARCO established a task force to revise the staging system of ONFH. The task force involved 29 experts who used a web-based survey for international collaboration. Content validity ratios for each answer were calculated to identify the levels of agreement. For the rating queries, a consensus was defined when more than 70% of the panel members scored a 4 or 5 rating on a 5-point scale. Results: Response rates were 93.1%-100%, and through the 4-round Delphi study, the 1994 ARCO classification for ONFH was successfully revised. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. This revised staging system does not incorporate the previous subclassification or quantitation parameters, but the panels agreed on the future development of a separate grading system for predicting disease progression. Conclusion: A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. ARCO approved and recommends this revised system as a universal staging of ONFH.

KW - Delphi

KW - avascular necrosis

KW - hip

KW - osteonecrosis

KW - staging

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The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head

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Keywords

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