Chinese Experts' Consensus on the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults
Bibliographic record
Abstract
Avascular necrosis or osteonecrosis of the femoral head (ONFH) is a recalcitrant and common disease characterized by death of the osteocytes and the bone marrow, and is caused by inadequate blood supply to the affected segment of the subchondral bone. Experts' suggestions of the diagnosis and treatment osteonecrosis of the femoral head were described for diagnosis, treatment and evaluation of ONFH in 2006. The Group of Microsurgery, Chinese Orthopaedic Association, Chinese Medical Association, and Group of Bone defect and Osteonecrosis, Chinese Association of Reparative and Reconstructive Surgery, and the editorial board of the Chinese Journal of Orthopaedics sponsored the senior experts' seminar on ONFH and updated the experts' suggestions in March 2012. All members of the Microsurgery groups and senior experts were invited to discuss the latest concepts and debate on the diagnosis and treatment of ONFH. Finally, an experts' consensus was given to provide a current basis for diagnosis, treatment and evaluation of ONFH. The Association Research Circulation Osseous (ARCO) and the American Academy of Orthopaedic Surgeons (AAOS) states that ONFH is not a specific diagnostic entity, but is considered a final common pathway for many diseases that can disrupt blood supply to the femoral head causing cell death within the femoral head. Histologically, ONFH is characterized by dead osteocytes, necrotic marrow elements, and lack of vasculature in a defined region in the femoral head; in most cases, these changes ultimately lead to collapse of the subchondral bone and the destruction of the hip joint in patients1. The etiology of ONFH includes traumatic and non-traumatic causes. ONFH commonly occurs after direct trauma, such as hip dislocation or femoral neck fracture. Pathogenesis of non-traumatic ONFH is not well understood, and in China the main risk factors include corticosteroid use, alcoholism, decompression sickness, and sickle cell anemia etc2-4. CT: sclerotic bone and cystic change MRI: crescent sign Staging is developed as a method to treat a disease during the various developmental phases. A number of classification systems for ONFH staging have been developed, including the ARCO9 (Association Research Circulation Osseous), Stulberg10 and Ficat11. The experts' consensus suggested that the ARCO international classification system is considered most useful: Early stage (ARCO 0 stage–I stage), middle stage (ARCO II stage–IIIb stage) and lately stage (ARCO IIIc–IV stage). Management alternatives for ONFH vary from joint salvaging procedures including non-operative treatment and operative treatment. Factors affecting the outcome of these procedures include patient's age, etiology and stage of osteonecrosis, in addition to the size and location of the osteonecrotic lesion. Core decompression is usually combined with implants of bone marrow stromal cells19-21(implantation of autologous bone-marrow cells). Many studies have reported the efficacy of this surgical technique22, 23. Young adults: core decompression (with implants included bone marrow stromal cells), vascularized bone-grafting, and non-vascularized bone-grafting (15% < necrosis volume <30%). Middle-age: core decompression, vascularized bone-grafting, non-vascularized bone-grafting and joint arthroplasty. Older people (>55 years old): joint arthroplasty, bipolar/tripolar hemiarthroplasty or total hip replacement. Assessment of ONFH therapy can be determined by clinical and imaging evaluations. The hip rate scale system (Harris38, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 39, 40, Chinese Orthopaedic Association41, etc.) can be used to evaluate clinical outcomes. Meanwhile, gait analysis is recommended to aid the clinical data. Imaging evaluation can be conducted by X-ray and MRI scans. A concentric circle template can be used to observe the shape of femoral head, joint space, and the change in the acetabulum. Additional Digital Subtraction Angiography should be done in the vascular bone transplant cases, to assess the blood supplement and recovery42.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.007 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".