The Classification Of Femur Head Necrosis:A Systematic Review And Evaluation Of The Consistency

ObjectiveFemur head necrosis has been increasely highlighted because of the disabling results and the high-risk in youngster.Recently,Lots of hip preserved treatments appear to delay progression of this disease.For the reason of heterogeneity across different studies,however,efficacy of each treatments are hardly evaluated.The use of diverse classification methods,as one of the factor causing heterogeneity,are treated as a essential way to describe the condition and progression of disease.Thus,more standardized process of classification system should be further studied.In addition,since the different understanding across researchers,consistency between evaluators when execute this classify process require verify.MethodsThe systematic review: By retrieving the Pubmed?Embase?Cochrane library,the most three authoritative database,we included studies according with inclusion criteria after rigorous screening.Then information of the classification methods used by included studies were collected.For the similar basis between classifications,the evaluation points were extracted.And according these points we tried to synthesized a principle letting mutual transform across classifications be achieved.The consistency evaluation: We randomly selected 50 patients diagnosed with ONFH in Guangzhou University of Traditional Chinese Medicine,the first affiliated hospital from October,2016 to this day.X-ray film of bilateral hip joint were collected an evaluated by 4 orthopedists with different clinical experience.Several classification systems,including Ficat staging,Steinberg staging,ARCO staging,JOA staging,JIC classification,were use by them to evaluate this patients.Then Kappa value between any two of them were calculated to evaluate the consistency.Results254 studies were included in our systematic review.4 main staging method were respectively use by 88.98% of whole included studies,including Ficat staging(59.84%),Steinberg staging(13.39%),ARCO staging(9.84%),JOA staging(5.91).In addition,as another type of classification system,JIC classification was used by 12.20% of the included studies.In senior orthopedists,Ficat staging,Steinberg staging,ARCO staging appear a relatively high consistency,especially the ARCO staging system.In contrast,JOA staging and JIC classification system have showed low consistency relatively.In junior orthopedists,however,these two system were revealed relatively high consistency compared with senior orthopedists,but Ficat staging system were revealed relatively low consistency in junior orthopedists.The volume of necrosis area,as one of indicator of collapse risk,has appeared a obvious low consistency,but degree of collapse,another indicator of disease severity,was proved have a high consistency.ConclusionThough the analysis above,several evaluation points were found:(1)MRI has been used as a accurate diagnosis method for ONFH in early stage;(2)Symptoms and signs should not be part of a classification system;(3)Crescent sign is a significant indicator of collapse;(4)The degree of collapse revealed the progression of ONFH;(5)The volume of necrosis area has been considered as a factor effecting prognosis of ONFH;(6)The JIC classification system could evaluate the prognosis of ONFH effectively as a method describing position of necrosis area;(7)The appearance of osteoarthritis is another factor of progression of ONFH after collapse.For these similar points,the four classification system could be converted to one another.And we suggest more information describing the points above should be reported as comprehensive as possible in article.As to consistency of these classification system,we found the following characteristics:(1)Ficat staging,Steinberg staging and ARCO staging system appeared relatively high consistency,but Ficat staging was not likely so in senior orthopedists;(2)JOA staging and JIC classification system have low consistency in senior orthopedists,but it appeared high consistency in junior orthopedists;(3)The volume of necrosis area appeared generally low consistency;(4)The degree of collapse was proved a high consistency through the evaluation of X-ray film.