Osteonecrosis of the Femoral Head: Etiology, Pathogenesis, Natural History, and ARCO Staging
Main Article Content
Keywords
ONFH, Etiology, Pathogenesis, ARCO classification
Abstract
Nontraumatic osteonecrosis of the femoral head (ONFH) usually affects young and middle-aged adults and frequently leads to femoral head collapse and subsequent arthritis of the hip. The incidence of the disease is increasing in accordance with the increased use of glucocorticoids for the adjuvant therapy of leukemia and other myelogenous diseases as well as the management of organ transplantation. This review provides up-to-date knowledge on the etiology and pathogenesis, natural history of ONFH, and it also describes Association Research Circulation Osseous (ARCO) classification criteria of glucocorticoids- and alcohol-
associated ONFH, and the 2019 ARCO staging system.
References
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3. Kahlstrom SC, Phemister DB. Bone Infarcts: Case Report with Autopsy Findings. Am J Pathol. 1946;22(5):947–63.
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7. Dale T. Bone necrosis in divers; caisson disease. Acta Chir Scand. 1952;104(2–3):153–6.
8. Chung SM, Ralston EL. Necrosis of the femoral head associated with sickle-cell anemia and its genetic variants. A review of the literature and study of thirteen cases. J Bone Joint Surg Am. 1969;51(1):33–58.
9. Ravault PP, Lejeune E, Colomb D, Fries D. [Osteonecrosis of the femur head associated with corticotherapy]. Rev Rhum Mal Osteoartic. 1962;29:546–50.
10. Arlet J, Franck JL, Nghiem L, Solera ML, de Graeve J. [Multiple bone necroses and familial type I hyperlipemia. Apropos of a case report]. Rev Rhum Mal Osteoartic. 1983;50(2):149–53.
11. Pierre-Jacques H, Glueck CJ, Mont MA, Hungerford DS. Familial heterozygous protein-S deficiency in a patient who had multifocal osteonecrosis. A case report. J Bone Joint Surg Am. 1997;79(7):1079–84. http:/dx/doi.org/10.2106/00004623-199707000-00017
12. Glueck CJ, Freiberg R, Tracy T, Stroop D, Wang P. Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis. Clin Orthop Relat Res. 1997(334):43–56.
13. Jones LC, Mont MA, Le TB, Petri M, Hungerford DS, Wang P, et al. Procoagulants and osteonecrosis. J Rheumatol. 2003;30(4):783–91.
14. Zalavras CG, Vartholomatos G, Dokou E, Malizos KN. Genetic background of osteonecrosis: associated with thrombophilic mutations? Clin Orthop Relat Res. 2004(422):251–5.
15. Bjorkman A, Svensson PJ, Hillarp A, Burtscher IM, Runow A, Benoni G. Factor V leiden and prothrombin gene mutation: risk factors for osteonecrosis of the femoral head in adults. Clin Orthop Relat Res. 2004(425):168–72.
16. Glueck CJ, Fontaine RN, Gruppo R, Stroop D, Sieve-Smith L, Tracy T, et al. The plasminogen activator inhibitor-1 gene, hypofibrinolysis, and osteonecrosis. Clin Orthop Relat Res. 1999(366):133–46. http:/dx/doi.org/10.1097/00003086-199909000-00017
17. Glueck CJ, Freiberg RA, Fontaine RN, Tracy T, Wang P. Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res. 2001(386):19–33. http:/dx/doi.org/10.1097/00003086-200105000-00004
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20. Glueck CJ, Freiberg RA, Boppana S, Wang P. Thrombophilia, hypofibrinolysis, the eNOS T-786C polymorphism, and multifocal osteonecrosis. J Bone Joint Surg Am. 2008;90(10):2220–9. http:/dx/doi.org/10.2106/JBJS.G.00616
21. Kim T, Hong JM, Lee J, Oh B, Park EK, Lee C, et al. Promoter polymorphisms of the vascular endothelial growth factor gene is associated with an osteonecrosis of the femoral head in the Korean population. Osteoarthritis Cartilage. 2008;16(3):287–91. http:/dx/doi.org/10.1016/j.joca.2007.06.017
22. Koo KH, Lee JS, Lee YJ, Kim KJ, Yoo JJ, Kim HJ. Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis. J Orthop Res. 2006;24(8):1722–8. http:/dx/doi.org/10.1002/jor.20164
23. Lee YJ, Lee JS, Kang EH, Lee YK, Kim SY, Song YW, et al. Vascular endothelial growth factor polymorphisms in patients with steroid-induced femoral head osteonecrosis. J Orthop Res. 2012;30(1):21–7. http:/dx/doi.org/10.1002/jor.21492
24. Abu-Shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003;25(1):13–24.
25. Dzik-Jurasz AS, Brooker S, Husband JE, Tait D. What is the prevalence of symptomatic or asymptomatic femoral head osteonecrosis in patients previously treated with chemoradiation? A magnetic resonance study of anal cancer patients. Clin Oncol (R Coll Radiol). 2001;13(2):130–4.
26. Hedri H, Cherif M, Zouaghi K, Abderrahim E, Goucha R, Ben Hamida F, et al. Avascular osteonecrosis after renal transplantation. Transplant Proc. 2007;39(4):1036–8. http:/dx/doi.org/10.1016/j.transproceed.2007.02.031
27. Hutter CD. Dysbaric osteonecrosis: a reassessment and hypothesis. Med Hypotheses. 2000;54(4):585–90. http:/dx/doi.org/10.1054/mehy.1999.0901
28. Jones JP. [Epidemiological risk factors for non-traumatic osteonecrosis]. Orthopade. 2000;29(5):370–9. http:/dx/doi.org/10.1007/s001320050458
29. Katz K, Horev G, Grunebaum M, Yosipovitch Z. The natural history of osteonecrosis of the femoral head in children and adolescents who have Gaucher disease. J Bone Joint Surg Am. 1996;78(1):14–9. http:/dx/doi.org/10.2106/00004623-199601000-00003
30. Rueda JC, Duque MA, Mantilla RD, Iglesias-Gamarra A. Osteonecrosis and antiphospholipid syndrome. J Clin Rheumatol. 2009;15(3):130–2. http:/dx/doi.org/10.1097/RHU.0b013e31819dbd20
31. Sayarlioglu M, Yuzbasioglu N, Inanc M, Kamali S, Cefle A, Karaman O, et al. Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus. Rheumatol Int. 2012;32(1):177–82.
32. Shibatani M, Fujioka M, Arai Y, Takahashi K, Ueshima K, Okamoto M, et al. Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head. Acta Orthop. 2008;79(5):631–6. http:/dx/doi.org/10.1080/17453670810016641
33. Tauchmanova L, De Rosa G, Serio B, Fazioli F, Mainolfi C, Lombardi G, et al. Avascular necrosis in long-term survivors after allogeneic or autologous stem cell transplantation: a single center experience and a review. Cancer. 2003;97(10):2453–61.
34. Tektonidou MG, Moutsopoulos HM. Immunologic factors in the pathogenesis of osteonecrosis. Orthop Clin North Am. 2004;35(3):259–63, vii. http:/dx/doi.org/10.1016/j.ocl.2004.02.003
35. Toklu AS, Cimsit M. Dysbaric osteonecrosis in Turkish sponge divers. Undersea Hyperb Med. 2001;28(2):83–8.
36. Winquist EW, Bauman GS, Balogh J. Nontraumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review. Am J Clin Oncol. 2001;24(6):603–6. http:/dx/doi.org/10.1097/00000421-200112000-00015
37. Yoon BH, Jones LC, Chen CH, Cheng EY, Cui Q, Drescher W, et al. Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 1: Glucocorticoid-Associated Osteonecrosis. J Arthroplasty. 2019;34(1):163–8 e1. http:/dx/doi.org/10.1016/j.arth.2018.09.005
38. Yoon BH, Jones LC, Chen CH, Cheng EY, Cui Q, Drescher W, et al. Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis. J Arthroplasty. 2019;34(1):169–74 e1. http:/dx/doi.org/10.1016/j.arth.2018.09.006
39. Cui Q, Jo WL, Koo KH, Cheng EY, Drescher W, Goodman SB, et al. ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head. J Korean Med Sci. 2021;36(10):e65. http:/dx/doi.org/10.3346/jkms.2021.36.e65
40. Koo KH, Jeong ST, Jones JP, Jr. Borderline necrosis of the femoral head. Clin Orthop Relat Res. 1999(358):158–65.
41. Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763.
42. Cui Q, Wang GJ, Balian G. Steroid-induced adipogenesis in a pluripotential cell line from bone marrow. J Bone Joint Surg Am. 1997;79(7):1054–63. http:/dx/doi.org/10.2106/00004623-199707000-00012
43. Cui Q, Wang Y, Saleh KJ, Wang GJ, Balian G. Alcohol-induced adipogenesis in a cloned bone-marrow stem cell. J Bone Joint Surg Am. 2006;88 Suppl 3:148–54. http:/dx/doi.org/10.2106/JBJS.F.00534
44. Wang GJ, Sweet DE, Reger SI, Thompson RC. Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg Am. 1977;59(6):729–35.
45. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006;88 Suppl 3:35–40. http:/dx/doi.org/10.1177/1120700020978587
46. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34–41.
47. Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7(5):601–5. http:/dx/doi.org/10.1007/s007760200108
48. Koo KH, Ahn IO, Kim R, Song HR, Jeong ST, Na JB, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology. 1999;213(3):715–22. http:/dx/doi.org/10.1148/radiology.213.3.r99dc06715
49. Kerboul M, Thomine J, Postel M, Merle d'Aubigne R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974;56(2):291–6.
50. Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, et al. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. J Arthroplasty. 2020;35(4):933–40. http:/dx/doi.org/10.1016/j.arth.2019.11.029
2. Freund E. Bilateral Aseptic Necrosis of the Femoral Head: Problems Arising in a Compensation Case. Ann Surg. 1936;104(1):100–6. http:/dx/doi.org/ 0.1097/00000658-193607000-00010
3. Kahlstrom SC, Phemister DB. Bone Infarcts: Case Report with Autopsy Findings. Am J Pathol. 1946;22(5):947–63.
4. Ikeuchi K, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Epidemiology of nontraumatic osteonecrosis of the femoral head in Japan. Mod Rheumatol. 2015;25(2):278–81. http:/dx/doi.org/10.3109/14397595.2014.932038
5. Kang JS, Park S, Song JH, Jung YY, Cho MR, Rhyu KH. Prevalence of osteonecrosis of the femoral head: a nationwide epidemiologic analysis in Korea. J Arthroplasty. 2009;24(8):1178–83. http:/dx/doi.org/10.1016/j.arth.2009.05.022
6. Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am. 2015;97(19):1604–27. http:/dx/doi.org/10.2106/JBJS.O.00071
7. Dale T. Bone necrosis in divers; caisson disease. Acta Chir Scand. 1952;104(2–3):153–6.
8. Chung SM, Ralston EL. Necrosis of the femoral head associated with sickle-cell anemia and its genetic variants. A review of the literature and study of thirteen cases. J Bone Joint Surg Am. 1969;51(1):33–58.
9. Ravault PP, Lejeune E, Colomb D, Fries D. [Osteonecrosis of the femur head associated with corticotherapy]. Rev Rhum Mal Osteoartic. 1962;29:546–50.
10. Arlet J, Franck JL, Nghiem L, Solera ML, de Graeve J. [Multiple bone necroses and familial type I hyperlipemia. Apropos of a case report]. Rev Rhum Mal Osteoartic. 1983;50(2):149–53.
11. Pierre-Jacques H, Glueck CJ, Mont MA, Hungerford DS. Familial heterozygous protein-S deficiency in a patient who had multifocal osteonecrosis. A case report. J Bone Joint Surg Am. 1997;79(7):1079–84. http:/dx/doi.org/10.2106/00004623-199707000-00017
12. Glueck CJ, Freiberg R, Tracy T, Stroop D, Wang P. Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis. Clin Orthop Relat Res. 1997(334):43–56.
13. Jones LC, Mont MA, Le TB, Petri M, Hungerford DS, Wang P, et al. Procoagulants and osteonecrosis. J Rheumatol. 2003;30(4):783–91.
14. Zalavras CG, Vartholomatos G, Dokou E, Malizos KN. Genetic background of osteonecrosis: associated with thrombophilic mutations? Clin Orthop Relat Res. 2004(422):251–5.
15. Bjorkman A, Svensson PJ, Hillarp A, Burtscher IM, Runow A, Benoni G. Factor V leiden and prothrombin gene mutation: risk factors for osteonecrosis of the femoral head in adults. Clin Orthop Relat Res. 2004(425):168–72.
16. Glueck CJ, Fontaine RN, Gruppo R, Stroop D, Sieve-Smith L, Tracy T, et al. The plasminogen activator inhibitor-1 gene, hypofibrinolysis, and osteonecrosis. Clin Orthop Relat Res. 1999(366):133–46. http:/dx/doi.org/10.1097/00003086-199909000-00017
17. Glueck CJ, Freiberg RA, Fontaine RN, Tracy T, Wang P. Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res. 2001(386):19–33. http:/dx/doi.org/10.1097/00003086-200105000-00004
18. Korompilias AV, Gilkeson GS, Ortel TL, Seaber AV, Urbaniak JR. Anticardiolipin antibodies and osteonecrosis of the femoral head. Clin Orthop Relat Res. 1997(345):174–80.
19. Seleznick MJ, Silveira LH, Espinoza LR. Avascular necrosis associated with anticardiolipin antibodies. J Rheumatol. 1991;18(9):1416–7. http:/dx/doi.org/10.1097/01.rhu.0000135559.95451.b2
20. Glueck CJ, Freiberg RA, Boppana S, Wang P. Thrombophilia, hypofibrinolysis, the eNOS T-786C polymorphism, and multifocal osteonecrosis. J Bone Joint Surg Am. 2008;90(10):2220–9. http:/dx/doi.org/10.2106/JBJS.G.00616
21. Kim T, Hong JM, Lee J, Oh B, Park EK, Lee C, et al. Promoter polymorphisms of the vascular endothelial growth factor gene is associated with an osteonecrosis of the femoral head in the Korean population. Osteoarthritis Cartilage. 2008;16(3):287–91. http:/dx/doi.org/10.1016/j.joca.2007.06.017
22. Koo KH, Lee JS, Lee YJ, Kim KJ, Yoo JJ, Kim HJ. Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis. J Orthop Res. 2006;24(8):1722–8. http:/dx/doi.org/10.1002/jor.20164
23. Lee YJ, Lee JS, Kang EH, Lee YK, Kim SY, Song YW, et al. Vascular endothelial growth factor polymorphisms in patients with steroid-induced femoral head osteonecrosis. J Orthop Res. 2012;30(1):21–7. http:/dx/doi.org/10.1002/jor.21492
24. Abu-Shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003;25(1):13–24.
25. Dzik-Jurasz AS, Brooker S, Husband JE, Tait D. What is the prevalence of symptomatic or asymptomatic femoral head osteonecrosis in patients previously treated with chemoradiation? A magnetic resonance study of anal cancer patients. Clin Oncol (R Coll Radiol). 2001;13(2):130–4.
26. Hedri H, Cherif M, Zouaghi K, Abderrahim E, Goucha R, Ben Hamida F, et al. Avascular osteonecrosis after renal transplantation. Transplant Proc. 2007;39(4):1036–8. http:/dx/doi.org/10.1016/j.transproceed.2007.02.031
27. Hutter CD. Dysbaric osteonecrosis: a reassessment and hypothesis. Med Hypotheses. 2000;54(4):585–90. http:/dx/doi.org/10.1054/mehy.1999.0901
28. Jones JP. [Epidemiological risk factors for non-traumatic osteonecrosis]. Orthopade. 2000;29(5):370–9. http:/dx/doi.org/10.1007/s001320050458
29. Katz K, Horev G, Grunebaum M, Yosipovitch Z. The natural history of osteonecrosis of the femoral head in children and adolescents who have Gaucher disease. J Bone Joint Surg Am. 1996;78(1):14–9. http:/dx/doi.org/10.2106/00004623-199601000-00003
30. Rueda JC, Duque MA, Mantilla RD, Iglesias-Gamarra A. Osteonecrosis and antiphospholipid syndrome. J Clin Rheumatol. 2009;15(3):130–2. http:/dx/doi.org/10.1097/RHU.0b013e31819dbd20
31. Sayarlioglu M, Yuzbasioglu N, Inanc M, Kamali S, Cefle A, Karaman O, et al. Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus. Rheumatol Int. 2012;32(1):177–82.
32. Shibatani M, Fujioka M, Arai Y, Takahashi K, Ueshima K, Okamoto M, et al. Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head. Acta Orthop. 2008;79(5):631–6. http:/dx/doi.org/10.1080/17453670810016641
33. Tauchmanova L, De Rosa G, Serio B, Fazioli F, Mainolfi C, Lombardi G, et al. Avascular necrosis in long-term survivors after allogeneic or autologous stem cell transplantation: a single center experience and a review. Cancer. 2003;97(10):2453–61.
34. Tektonidou MG, Moutsopoulos HM. Immunologic factors in the pathogenesis of osteonecrosis. Orthop Clin North Am. 2004;35(3):259–63, vii. http:/dx/doi.org/10.1016/j.ocl.2004.02.003
35. Toklu AS, Cimsit M. Dysbaric osteonecrosis in Turkish sponge divers. Undersea Hyperb Med. 2001;28(2):83–8.
36. Winquist EW, Bauman GS, Balogh J. Nontraumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review. Am J Clin Oncol. 2001;24(6):603–6. http:/dx/doi.org/10.1097/00000421-200112000-00015
37. Yoon BH, Jones LC, Chen CH, Cheng EY, Cui Q, Drescher W, et al. Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 1: Glucocorticoid-Associated Osteonecrosis. J Arthroplasty. 2019;34(1):163–8 e1. http:/dx/doi.org/10.1016/j.arth.2018.09.005
38. Yoon BH, Jones LC, Chen CH, Cheng EY, Cui Q, Drescher W, et al. Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis. J Arthroplasty. 2019;34(1):169–74 e1. http:/dx/doi.org/10.1016/j.arth.2018.09.006
39. Cui Q, Jo WL, Koo KH, Cheng EY, Drescher W, Goodman SB, et al. ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head. J Korean Med Sci. 2021;36(10):e65. http:/dx/doi.org/10.3346/jkms.2021.36.e65
40. Koo KH, Jeong ST, Jones JP, Jr. Borderline necrosis of the femoral head. Clin Orthop Relat Res. 1999(358):158–65.
41. Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763.
42. Cui Q, Wang GJ, Balian G. Steroid-induced adipogenesis in a pluripotential cell line from bone marrow. J Bone Joint Surg Am. 1997;79(7):1054–63. http:/dx/doi.org/10.2106/00004623-199707000-00012
43. Cui Q, Wang Y, Saleh KJ, Wang GJ, Balian G. Alcohol-induced adipogenesis in a cloned bone-marrow stem cell. J Bone Joint Surg Am. 2006;88 Suppl 3:148–54. http:/dx/doi.org/10.2106/JBJS.F.00534
44. Wang GJ, Sweet DE, Reger SI, Thompson RC. Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg Am. 1977;59(6):729–35.
45. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006;88 Suppl 3:35–40. http:/dx/doi.org/10.1177/1120700020978587
46. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34–41.
47. Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7(5):601–5. http:/dx/doi.org/10.1007/s007760200108
48. Koo KH, Ahn IO, Kim R, Song HR, Jeong ST, Na JB, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology. 1999;213(3):715–22. http:/dx/doi.org/10.1148/radiology.213.3.r99dc06715
49. Kerboul M, Thomine J, Postel M, Merle d'Aubigne R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974;56(2):291–6.
50. Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, et al. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. J Arthroplasty. 2020;35(4):933–40. http:/dx/doi.org/10.1016/j.arth.2019.11.029
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Aug 20, 2022
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How to Cite
Park, J.-W., Kim, H.-S., Lee, Y.-K., & Koo, K.-H. (2022). Osteonecrosis of the Femoral Head: : Etiology, Pathogenesis, Natural History, and ARCO Staging . Biologic Orthopedics Journal, 3(SP1), e28-e34. https://doi.org/10.22374/boj.v3iSP1.19
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Author Biographies
Jung-Wee Park, Seoul National University Bundang Hospital, Seongnam, South Korea
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South
Korea
Hong-Seok Kim, Seoul National University Bundang Hospital, Seongnam, South Korea
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South
Korea
Young-Kyun Lee, Seoul National University Bundang Hospital, Seongnam, South Korea
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South
Korea
Kyung-Hoi Koo, Seoul National University Bundang Hospital, Seongnam, South Korea; Seoul National University College of Medicine, Seoul, South Korea
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South
Korea
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea