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

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

doi:10.1016/j.arth.2022.02.009

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

Kyung Hoi Koo, Michael A. Mont, Quanjun Cui, Jeremy T. Hines, Byung Ho Yoon, Wendy M. Novicoff, Yun Jong Lee, Edward Y. Cheng, Wolf Drescher, Philippe Hernigou, Shin Yoon Kim, Nobuhiko Sugano, De Wei Zhao, Yong Chan Ha, Stuart B. Goodman, Takashi Sakai, Lynne C. Jones, Mel S. Lee, Takuaki Yamamoto, Young Kyun LeeYusuhn Kang, James Burgess, Dennis Chen, Nicole Quinlan, Jian Zhong Xu, Jung Wee Park, Hong Seok Kim

Orthopaedic Surgery

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Abstract

Background: The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. Methods: In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. Results: In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10⁻⁵). Conclusion: This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. Level of Evidence: Level III, diagnostic study.

Original language	English (US)
Pages (from-to)	1074-1082
Number of pages	9
Journal	Journal of Arthroplasty
Volume	37
Issue number	6
DOIs	https://doi.org/10.1016/j.arth.2022.02.009
State	Published - Jun 2022

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© 2022 Elsevier Inc.

Keywords

avascular necrosis
classification
femoral head
location
osteonecrosis
size

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Koo, K. H., Mont, M. A., Cui, Q., Hines, J. T., Yoon, B. H., Novicoff, W. M., Lee, Y. J., Cheng, E. Y., Drescher, W., Hernigou, P., Kim, S. Y., Sugano, N., Zhao, D. W., Ha, Y. C., Goodman, S. B., Sakai, T., Jones, L. C., Lee, M. S., Yamamoto, T., ... Kim, H. S. (2022). The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study. Journal of Arthroplasty, 37(6), 1074-1082. https://doi.org/10.1016/j.arth.2022.02.009

Koo, KH, Mont, MA, Cui, Q, Hines, JT, Yoon, BH, Novicoff, WM, Lee, YJ, Cheng, EY, Drescher, W, Hernigou, P, Kim, SY, Sugano, N, Zhao, DW, Ha, YC, Goodman, SB, Sakai, T, Jones, LC, Lee, MS, Yamamoto, T, Lee, YK, Kang, Y, Burgess, J, Chen, D, Quinlan, N, Xu, JZ, Park, JW & Kim, HS 2022, 'The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study', Journal of Arthroplasty, vol. 37, no. 6, pp. 1074-1082. https://doi.org/10.1016/j.arth.2022.02.009

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

abstract = "Background: The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. Methods: In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. Results: In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10−5). Conclusion: This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. Level of Evidence: Level III, diagnostic study.",

keywords = "avascular necrosis, classification, femoral head, location, osteonecrosis, size",

author = "Koo, {Kyung Hoi} and Mont, {Michael A.} and Quanjun Cui and Hines, {Jeremy T.} and Yoon, {Byung Ho} and Novicoff, {Wendy M.} and Lee, {Yun Jong} and Cheng, {Edward Y.} and Wolf Drescher and Philippe Hernigou and Kim, {Shin Yoon} and Nobuhiko Sugano and Zhao, {De Wei} and Ha, {Yong Chan} and Goodman, {Stuart B.} and Takashi Sakai and Jones, {Lynne C.} and Lee, {Mel S.} and Takuaki Yamamoto and Lee, {Young Kyun} and Yusuhn Kang and James Burgess and Dennis Chen and Nicole Quinlan and Xu, {Jian Zhong} and Park, {Jung Wee} and Kim, {Hong Seok}",

note = "Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = jun,

doi = "10.1016/j.arth.2022.02.009",

language = "English (US)",

volume = "37",

pages = "1074--1082",

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T1 - The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study

AU - Koo, Kyung Hoi

AU - Mont, Michael A.

AU - Cui, Quanjun

AU - Hines, Jeremy T.

AU - Yoon, Byung Ho

AU - Novicoff, Wendy M.

AU - Lee, Yun Jong

AU - Cheng, Edward Y.

AU - Drescher, Wolf

AU - Hernigou, Philippe

AU - Kim, Shin Yoon

AU - Sugano, Nobuhiko

AU - Zhao, De Wei

AU - Ha, Yong Chan

AU - Goodman, Stuart B.

AU - Sakai, Takashi

AU - Jones, Lynne C.

AU - Lee, Mel S.

AU - Yamamoto, Takuaki

AU - Lee, Young Kyun

AU - Kang, Yusuhn

AU - Burgess, James

AU - Chen, Dennis

AU - Quinlan, Nicole

AU - Xu, Jian Zhong

AU - Park, Jung Wee

AU - Kim, Hong Seok

PY - 2022/6

Y1 - 2022/6

N2 - Background: The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. Methods: In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. Results: In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10−5). Conclusion: This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. Level of Evidence: Level III, diagnostic study.

AB - Background: The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. Methods: In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. Results: In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10−5). Conclusion: This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. Level of Evidence: Level III, diagnostic study.

KW - avascular necrosis

KW - classification

KW - femoral head

KW - location

KW - osteonecrosis

KW - size

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

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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