The Journal of Bone and Joint Surgery (American). 2006;88:16-26.
doi:10.2106/JBJS.F.00457
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Systematic Analysis of Classification Systems for Osteonecrosis of the Femoral Head

Michael A. Mont, MD, German A. Marulanda, MD, Lynne C. Jones, PhD, Khaled J. Saleh, MD, MSc, FRCSC, Noah Gordon, MD, David S. Hungerford, MD and Marvin E. Steinberg, MD

Corresponding author:
Michael A. Mont, MD
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215.
E-mail address: Rhondamont{at}aol.com,
Mmont{at}lifebridgehealth.org

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker Orthopaedics and Smith and Nephew. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Stryker Orthopaedics and Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Multiple classification systems for osteonecrosis of the hip have been developed to assist physicians in the diagnosis and treatment of this potentially debilitating disorder. The purpose of this analysis was to delineate the classification systems utilized in reports published since 1985 and, through a comparison of the most commonly used systems, to identify consistent factors that would allow for cross-publication comparisons to be made.

Methods: We performed a PubMed search for reports of outcome studies concerning treatment methods for osteonecrosis of the hip. All studies of reported outcomes with greater than ten patients were included in the analysis. Various classification systems were tabulated to determine usage frequencies. The four most commonly used systems were then analyzed to determine common factors used for classification.

Results: One hundred and fifty-seven studies were available for analysis. Sixteen major classification systems that made use of more than one radiographic factor were identified, and nine of these systems had one to five modifications reported throughout the literature. Additionally, eleven other systems made use of single factors obtained from either magnetic resonance imaging or anatomic data. The review revealed that four classification systems accounted for greater than 85.4% of the reported studies. Parameters for these four systems were stratified to allow for uniformity of patient or study evaluation.

Conclusions: This analysis of the reported classification systems for osteonecrosis of the femoral head revealed several similarities between the most commonly used systems. An analysis of patients can be made with any of the four major systems if specific data are collected according to various magnetic resonance imaging and radiographic findings. This approach will allow for easier comparison of studies across different centers.

Level of Evidence: Prognostic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.


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