ArticleBMC musculoskeletal disorders2023
Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head.
Article in BMC musculoskeletal disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- Subject-Level Classification of Osteonecrosis of the Femoral Head from Wearable IMU Gait Data Using Multilevel Feature Fusion.Bioengineering (Basel, Switzerland) · 2026Article
- [Avascular Necrosis of the Femoral Head after Hodgkin Lymphoma Treatment: Analysis of Risk Factors and Mid-Term Outcomes after Total Hip Replacement].Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca · 2026Observational
- Relaxation Time Mapping of Early-Stage Osteonecrosis of the Femoral Head: An In Vivo Piglet Model Study.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2026Article
- Diagnostic performance and reader confidence of MRI-derived CT-like images in patients with femoral head necrosis.European radiology experimental · 2026Article
- Analysis of the efficacy of autologous adipose-derived stromal vascular fraction and calcium phosphate bone cement combined with core decompression in patients with femoral head necrosis: a retrospective study.BMC musculoskeletal disorders · 2026Article
- Clinical outcomes and risk factors for failure of nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone in treatment of early-stage osteonecrosis of the femoral head.International orthopaedics · 2025Article
- Osteonecrosis of the femoral head: treatment before the collapse. Experience with decompression and biological therapy.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Core decompression, allogenic fibula fixation, and pedicled fibula grafting are effective for osteonecrosis of femoral head.American journal of translational research · 2025Article
- Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study.Journal of orthopaedic surgery and research · 2024Article
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8 authors.
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Abstract
backgroundThe study was designed to evaluate the interobserver reliability and intraobserver repeatability of the 2021 Association Research Circulation Osseous (ARCO) classification and explore its guiding significance in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH).
methodsIn this retrospective study, we randomly selected and investigated 50 sets of preoperative computed tomography or magnetic resonance imaging scans from 96 patients (139 hips) to validate the reliability and repeatability of the 2021 ARCO classification. Patients with a nano-hydroxyapatite/polyamide-66 support rod were included in the clinical efficacy study. The Harris hip score (HHS) was used to assess hip function. Femoral head collapse of > 2 mm was considered radiological failure. Total hip arthroplasty (THA) was performed for clinical failure, and follow-up was discontinued.
resultsThe average kappa value of interobserver consistency was 0.652. The average rate of consistency was 90.25%, and the average kappa value of intraobserver consistency was 0.836. Eighty-two patients (122 hips) were enrolled and followed up for a mean of 43.57 ± 9.64 months. There was no significant difference in the HHS among the three groups before surgery, but the difference was statistically significant at the last follow-up. Among them, types 1 and 2 had significantly higher scores at the last follow-up than preoperatively (P < 0.05), whereas type 3 had a lower score at the last follow-up than preoperatively, although the difference was not statistically significant (P > 0.05).According to the imaging evaluation, the failure rate of type 1, 2, and 3 at the last follow-up was 0%, 19%, and 87%, respectively. Univariate analysis showed that the femoral head survival rate of radiography was significantly affected by the new classification system (P = 0.00). At the last follow-up, the incidence rate of THA in type 1, 2, and 3 was 5%, 7%, and 31%, respectively. Univariate analysis showed that the femoral head survival rate was significantly affected by the new classification system (P = 0.001).
conclusionsThe 2021 ARCO classification for early-stage ONFH shows substantial consistency and repeatability. We do not recommend femoral head-preserving surgery for patients with type 3 ONFH.
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