Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines

Abstract

Introduction: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines. Materials and Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH. Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.

Protocols for clinical practice guidelines

“…Guideline developers globally should advocate for open guideline registration and work to enhance adherence. Guideline developers and registration platform administrators also need to ensure that guidelines are registered on the correct platform, given that we identified two protocols 31,39 that were registered on a systematic review platform (PROSPERO). Another recognized international guideline registry is the one hosted by the Guidelines International Network (GIN) that involves a payment for nonmembers once the guideline is completed and published in a journal or posted on a website.…”

Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head

“…Therefore, many scholars have focused on how to improve the success rate of preserving the femoral head in patients with early ONFH [ 5 – 7 ]. Previous studies have shown that the size and location of lesions are important factors affecting the postoperative outcome of early femoral head necrosis [ 8 – 10 ]. Therefore, many studies have attempted to predict the success rate of head preservation surgery in patients with early ONFH by typing the site of the necrotic area [ 11 – 14 ].…”