Guidelines
Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head

https://doi.org/10.1016/j.jos.2020.06.013Get rights and content

Abstract

Purpose

The Clinical Practice Guidelines for Osteonecrosis of the Femoral Head (ONFH) 2019 Edition, written by the working group for ONFH guidelines of the Japanese Investigation Committee (JIC) for ONFH under the auspices of the Japanese Ministry of Health, Labour, and Welfare and endorsed by the Japanese Orthopaedic Association, were published in Japanese in October 2019. The objective of this guideline is to provide a support tool for decision-making between doctors and patients.

Methods

Procedures for developing this guideline were based on the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014, which proposed an appropriate method for preparing clinical guidelines in Japan.

Results

This clinical practice guideline consists of 7 chapters: epidemiology; pathology; diagnosis; conservative therapy; surgical treatment: bone transplantation/cell therapy; surgical treatment: osteotomy; and surgical treatment: hip replacement. Twelve background questions and 13 clinical questions were determined to define the basic features of the disease and to be addressed when deciding treatment in daily practice, respectively.

Conclusions

The clinical practice guidelines for the ONFH 2019 edition will be useful for physicians, investigators, and medical staff in clinical practice, as well as for patients, during the decision-making process when defining how to treat ONFH.

Introduction

Osteonecrosis of the femoral head (ONFH) has been reported to be a common cause of acute hip pain in the early stage, following the progressive collapse of the femoral head with joint destruction. ONFH is also known as avascular necrosis or ischemic necrosis because of its pathological features, and it is thought to be caused by ischemia. Osteonecrosis caused by trauma (dislocation and/or fracture), decompression sickness, and radiation is defined as secondary osteonecrosis. Systemic steroid administration, habitual alcohol intake, and smoking are factors associated with ONFH, which have been addressed in this guideline; however, the mechanism of ONFH occurrence has not yet been elucidated, and its causes are still unknown.

To standardize the medical treatment for ONFH, it is necessary to develop new clinical practice guidelines, addressing the most relevant management and intervention strategies based on recent literature. In 2015, the working group for ONFH guidelines was organized mainly by the members of the Japanese Investigation Committee (JIC) for ONFH under the auspices of the Japanese Ministry of Health, Labour, and Welfare, and the Japanese Orthopaedic Association (JOA) established the development committee of clinical practice guidelines for ONFH in February 2018.

Section snippets

Results of the literature search

The procedure for creating these guidelines was in accordance with the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014 (MINDS 2014) [1]. This clinical practice guideline is divided into seven chapters: epidemiology; pathology; diagnosis; conservative therapy; surgical treatment: bone transplantation/cell therapy; surgical treatment: osteotomy; and surgical treatment: hip replacement. Regarding epidemiology, pathology, and diagnosis, 12

Strengths of recommendations and evidence

In this guideline, a systematic review was conducted of each study design and outcome based on qualitative or quantitative meta-analysis on many pieces of evidence. In making recommendations, the concept of “benefits and harms” was emphasized. In other words, it was important to describe not only the effects (benefits) but also the occurrence of adverse effects in medical treatment.

The strength of recommendations in CQs were determined in accordance with the specifications in Table 2. Grade 5

Scope and purpose

This guideline is intended to provide concise, patient focused, up-to-date, evidence-based, expert consensus recommendations for the management of ONFH. Clinical practice guidelines are not evidence aggregation but guide evidence-based practice. This guideline helps doctors and patients to reach consensus in medical practice and support the appropriate selection of treatments, which have been applied to approximately 60–95% of patients based on the available evidence. Therefore, neither is it a

Target users

These guidelines have been developed to provide assistance for physicians and medical staff in clinical practice as well as a helpful resource for patients with ONFH, patient representative groups, and health care administrators.

Chapter 1: Epidemiology

BACKGROUND QUESTION 1-1. What are the basic characteristics of ONFH in Japan (e.g., sex and age distribution)?

The male-to-female ratio of ONFH in Japan is 1.2–2.1: 1, indicating that ONFH is more frequent among men. When the age distribution is examined by 10-year intervals, it is found that the proportion of men aged 30–59 years is high and ONFH is a disease that occurs most often from young adults to middle age. Although a similar tendency is observed among women, the findings vary depending

Funding

This study was supported by Health Labour Sciences Research Grant, the Ministry of Health Labour and Welfare Research Program on Rare and Intractable Disease Grant (JPMH20FC1010), Japan.

Declaration of competing interest

Conflicts of interest were confirmed by self-reporting of all co-authors and the members of the working group for ONFH guidelines. No company was directly involved in the guideline recommendations.

Acknowledgements

We thank the Japanese Orthopaedic Association and the Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan.

Working group for ONFH guidelines

Junichi Nakamura9, MD, PhD, Yuma Sakamoto10, MD, PhD, Toru Ichiseki4, MD, PhD, Tamon Kabata11, MD, PhD, Yoshitomo Kajino11, MD, PhD, Kiyokazu Fukui4, MD, PhD, Taisuke Seki12 MD, PhD, Shigekazu Mizokawa13, MD, PhD, Masashi Ishida14, MD, PhD, Masazumi Saito14, MD, PhD, Yoichi Ohta15,

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    Working group for ONFH guidelines are listed at the Acknowledgments section.

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