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Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis
Authors:Byung-Ho Yoon  Lynne C. Jones  Chung-Hwan Chen  Edward Y. Cheng  Quanjun Cui  Wolf Drescher  Wakaba Fukushima  Valerie Gangji  Stuart B. Goodman  Yong-Chan Ha  Philippe Hernigou  Marc Hungerford  Richard Iorio  Woo-Lam Jo  Vikas Khanduja  Harry Kim  Shin-Yoon Kim  Tae-Young Kim  Kyung-Hoi Koo
Affiliation:1. Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea;2. Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research Johns Hopkins University School of Medicine, Baltimore, MD;3. Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;4. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN;5. Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA;6. Department of Orthopedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany;7. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan;8. Department of Rheumatology and Physical Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium;9. Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA;10. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea;11. Department of Orthopaedic Surgery, Hôpital Henri Mondor, Creteil, France;12. Department of Orthopedic Surgery, Mercy Medical Center, Baltimore, MD;13. Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY;14. Department of Orthopaedic Surgery, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea;15. Department of Trauma & Orthopaedics, Addenbrooke''s Hospital, Cambridge University Hospitals, Cambridge, UK;p. Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX;q. Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Republic of Korea;r. Department of Orthopedic Surgery, KonKuk University Medical Center, Seoul, South Korea;s. Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, South Korea;t. Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;u. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea;v. Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, South Korea;w. Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore, Baltimore, MD;x. Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
Abstract:

Background

Although alcohol is a leading risk factor for osteonecrosis of the femoral head (ONFH) and its prevalence reportedly ranges from 20% to 45%, there are no unified classification criteria for this subpopulation. In 2015, Association Research Circulation Osseous decided to develop classification criteria for alcohol-associated ONFH.

Methods

In June of 2017, Association Research Circulation Osseous formed a task force to conduct a Delphi survey. The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries. Each round of the Delphi survey included questionnaires, analysis of replies, and feedback reports to the panel. After 3 rounds of the survey, consensus was reached on the classification criteria. The response rates for the 3 Delphi rounds were 100% (round 1), 96% (round 2), and 100% (round 3).

Results

The consensus on the classification criteria of alcohol-associated ONFH included the following: (1) patients should have a history of alcohol intake >400 mL/wk (320 g/wk, any type of alcoholic beverage) of pure ethanol for more than 6 months; (2) ONFH should be diagnosed within 1 year after alcohol intake of this dose; and (3) patients should not have other risk factor(s).

Conclusion

ARCO-established classification criteria to standardize clinical studies concerning AA-ONFH.
Keywords:osteonecrosis  avascular necrosis  hip  femoral head  alcohol  Delphi
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