LAUSR

In this issue, Zhao et al [1] present a comprehensive set of guidelines on the presentation and management of osteonecrosis of the femoral head (ONFH). ONFH affects millions of people worldwide, particularly the elderly; even so, there is little public discourse about the disease, including preventative measures, signs and symptoms, and treatment options. Early ONFH may go undetected and the treatment options are mostly surgical, which means that public information about the disease and early detection are of great importance. The 2019 guidelines presented here build upon the information and suggestions put forth in “Chinese Guidelines for the Clinical Diagnosis and Treatment of Femoral Head Necrosis in Adults (2016)” [2], as well as drawing information and current practices from other society guidelines for ONFH (e.g., 2019 Association Research Circulation Osseous (ARCO) Staging System from the 2019, ARCO Conference). The guidelines detail the diagnostic criteria for ONFH, including clinical features, various imaging techniques (including conventional radiography, computed tomography, magnetic resonance imaging, and radionuclide examination), bone biopsies, and presentation at different pathological stages, with particular regard to vascularisation of the tissue. Furthermore, the guidelines provide instruction for differential diagnosis of disorders that may appear similar to that of ONFH, such as hip osteoarthritis, insufficiency and traumatic fractures, ankylosing spondylitis, and rheumatoid arthritis, amongst others. The guidelines also present an updated version of the ARCO Staging System, which was presented and approved at the “2019 ARCO Conference” in Dalian, People's Republic of China, providing a better system to assess the pathological stage of osteonecrosis. The guidelines provide a diagnostic flowchart to aid clinicians in making an appropriate diagnosis of ONFH at different stages of progression. Prevention and treatment strategies are discussed in the guidelines, providing both surgical and nonsurgical treatment options for patients at different stages of the disease. Lastly, post-treatment evaluation practices are presented, which may help clinicians determine if their treatment strategies are efficacious, or if any modifications are required. Clinicians and researchers should work closely together to ensure that patients receive the most effective and modern care available and that