The Association Research Circulation Osseous (ARCO) classification is a hip joint specific international standard that stages osteonecrotic changes, from 0 (no disease) to 5 (complete joint destruction), (Table 4).
Chronic painful secondary arthritis develops from progressive flattening and collapse of the femoral head (Figure 1, 3), The prevalence of humeral head osteonecrosis on radiographs was 28 percent in one population of patients; in another study, 48 percent of adults with SCD-SS were found to have radiographic abnormalities suggestive of healed and remodeled osteonecrotic lesions.
The most commonly used classification for osteonecrosis of the femoral head was developed by Ficat and Arlet and is based on radiographic changes; 95% of the patients with less than 30% osteonecrotic lesion in the femoral head are asymptomatic for more than 5 years; however, the symptoms start with lesion increasing by 50%.
Patients who develop osteonecrosis should be comprehensively managed to include elimination of trauma, avoidance of removable dental prosthesis if the denture-bearing area is within the osteonecrotic field, assurance of adequate nutritional intake, and discontinuation of tobacco and alcohol use.
What is not clear from their findings is whether the osteonecrotic cases reported included only athletes or if the respondent answered by including all patients treated with OCS over their entire clinical practice.
The development of bisphosphonate-related osteonecrotic lesions of the jaw (BRONJ) is a clinical problem where spontaneous exposure of alveolar bone occurs or, much worse, the patient presenting for routine dental extractions or periodontal curettage, develops an area of necrotic bone that does not respond to conservative treatment or surgical management.