{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:31:58Z","timestamp":1784287918915,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Health Labour and Welfare, Japan","award":["20FC1010"],"award-info":[{"award-number":["20FC1010"]}]},{"name":"Ministry of Health Labour and Welfare, Japan","award":["23FC1045"],"award-info":[{"award-number":["23FC1045"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,19]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective observational study of a nationwide database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measure<\/jats:title><jats:p>The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median time to surgery was 9 months (IQR 4\u201322 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018\u2009and p&lt;0.001, respectively), in early stage ONFH with no or mild joint destruction (stages II and III, p&lt;0.001), and with joint preserving surgery (p&lt;0.001). The proportion without surgery was 75.8% at 3 months, 59.6% at 6 months, 48.2% at 9 months, 40.5% at 1 year, 22.2% at 2 years and 8.3% at 5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ONFH has been considered to be an intractable disease that often requires surgical treatment, but the fact that surgery was performed in more than half of the patients within 9 months from diagnosis suggests severe disease with a significant clinical impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>Chiba University ID1049.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082342","type":"journal-article","created":{"date-parts":[[2024,3,30]],"date-time":"2024-03-30T02:13:45Z","timestamp":1711764825000},"page":"e082342","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Time elapsed from definitive diagnosis to surgery for osteonecrosis of the femoral head: a nationwide observational study in Japan"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4005-8832","authenticated-orcid":false,"given":"Junichi","family":"Nakamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wakaba","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9352-465X","authenticated-orcid":false,"given":"Wataru","family":"Ando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-8408","authenticated-orcid":false,"given":"Shigeo","family":"Hagiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3321-9389","authenticated-orcid":false,"given":"Yuya","family":"Kawarai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Shiko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Kawasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Sakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Arishima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etsuo","family":"Chosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Fujimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiharu","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Imagama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Inaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Ishibashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Ishidou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideya","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juji","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Jinno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamon","family":"Kabata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Kaku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Kaneuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Kishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seneki","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setsuro","family":"Komiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshikazu","family":"Kubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tokifumi","family":"Majima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiko","family":"Mashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Mawatari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenobu","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumasa","family":"Miyatake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goro","family":"Motomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nagoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihide","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Nakanishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuharu","family":"Nakashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nakasone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Nishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Nishiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Ohta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ohzono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Osaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisuke","family":"Seki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Shishido","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Shoji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Sudo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiaki","family":"Takagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Takao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-9414","authenticated-orcid":false,"given":"Sakae","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeyuki","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Tetsunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichiro","family":"Ueshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kengo","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuaki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuma","family":"Yamasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Yasunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiko","family":"Sugano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"2024043021570443000_14.3.e082342.1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1302\/0301-620X.73B1.1991778","article-title":"Natural history of nontraumatic avascular necrosis of the femoral head","volume":"73","author":"Ohzono","year":"1991","journal-title":"J Bone Joint Surg Br"},{"key":"2024043021570443000_14.3.e082342.2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jos.2020.06.013","article-title":"Japanese Orthopaedic Association 2019 guidelines for Osteonecrosis of the femoral head","volume":"26","author":"Ando","year":"2021","journal-title":"J Orthop Sci"},{"key":"2024043021570443000_14.3.e082342.3","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1292-x"},{"key":"2024043021570443000_14.3.e082342.4","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.1002\/art.30484","article-title":"Incidence of nontraumatic Osteonecrosis of the femoral head in the Japanese population","volume":"63","author":"Yamaguchi","year":"2011","journal-title":"Arthritis Rheum"},{"key":"2024043021570443000_14.3.e082342.5","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/art.27236","article-title":"Age at time of corticosteroid administration is a risk factor for Osteonecrosis in pediatric patients with systemic lupus erythematosus: a prospective magnetic resonance imaging study","volume":"62","author":"Nakamura","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2024043021570443000_14.3.e082342.6","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00264-018-3897-8","article-title":"Quality of life of patients with Osteonecrosis of the femoral head: a multicentre study","volume":"42","author":"Uesugi","year":"2018","journal-title":"Int Orthop"},{"key":"2024043021570443000_14.3.e082342.7","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/00003086-198606000-00037","article-title":"Results of conservative management of Osteonecrosis of the femoral head. A retrospective review","volume":"207","author":"Musso","year":"1986","journal-title":"Clin Orthop Relat Res"},{"key":"2024043021570443000_14.3.e082342.8","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01582"},{"key":"2024043021570443000_14.3.e082342.9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01454"},{"key":"2024043021570443000_14.3.e082342.10","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B3.14383"},{"key":"2024043021570443000_14.3.e082342.11","first-page":"191","article-title":"Transtrochanteric anterior Rotational Osteotomy of the femoral head in the treatment of Osteonecrosis affecting the hip: a new Osteotomy operation","volume":"130","author":"Sugioka","year":"1978","journal-title":"Clin Orthop Relat Res"},{"key":"2024043021570443000_14.3.e082342.12","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00302"},{"key":"2024043021570443000_14.3.e082342.13","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02441"},{"key":"2024043021570443000_14.3.e082342.14","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00264-020-04480-6","article-title":"Surgery trends for Osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan","volume":"44","author":"Kaneko","year":"2020","journal-title":"Int Orthop"},{"key":"2024043021570443000_14.3.e082342.15","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s12570-013-0216-0","article-title":"Articular collapse and surgical frequency in corticosteroid-associated Osteonecrosis of the femoral head and the knee: an MRI-based prospective study","volume":"5","author":"Shigemura","year":"2014","journal-title":"Eur Orthop Traumatol"},{"key":"2024043021570443000_14.3.e082342.16","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2188\/jea.JE20140162","article-title":"Temporal trends in characteristics of newly diagnosed nontraumatic Osteonecrosis of the femoral head from 1997 to 2011: a hospital-based sentinel monitoring system in Japan","volume":"25","author":"Takahashi","year":"2015","journal-title":"J Epidemiol"},{"key":"2024043021570443000_14.3.e082342.17","unstructured":"Ninomiya S . Chairman\u2019s report [in Japanese]. In: Ninomiya S , ed. Annual report of Japanese investigation committee for intractable diseases, idiopathic osteonecrosis of the femoral head, under the auspices ofMinistry of Health and Welfare. 1996: 3\u20138."},{"key":"2024043021570443000_14.3.e082342.18","doi-asserted-by":"publisher","DOI":"10.1007\/s007760200108"},{"key":"2024043021570443000_14.3.e082342.19","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3109\/s10165-011-0430-y","article-title":"Inter-observer and intra-observer Reliabilities of the Japanese Ministry of health, labor and welfare type classification system for Osteonecrosis of the femoral head","volume":"21","author":"Nakamura","year":"2011","journal-title":"Mod Rheumatol"},{"key":"2024043021570443000_14.3.e082342.20","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-009-1439-3"},{"key":"2024043021570443000_14.3.e082342.21","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.arth.2018.09.005","article-title":"Etiologic classification criteria of ARCO on femoral head Osteonecrosis part 1: glucocorticoid-associated Osteonecrosis","volume":"34","author":"Yoon","year":"2019","journal-title":"J Arthroplasty"},{"key":"2024043021570443000_14.3.e082342.22","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.arth.2018.09.006","article-title":"Etiologic classification criteria of ARCO on femoral head Osteonecrosis part 2: alcohol-associated Osteonecrosis","volume":"34","author":"Yoon","year":"2019","journal-title":"J Arthroplasty"},{"key":"2024043021570443000_14.3.e082342.23","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s11999-013-3220-3","article-title":"Treatment of femoral head Osteonecrosis in the United States: 16-year analysis of the nationwide inpatient sample","volume":"472","author":"Johnson","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"2024043021570443000_14.3.e082342.24","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1007\/s00264-018-3980-1","article-title":"Nationwide multicenter follow-up cohort study of hip arthroplasties performed for Osteonecrosis of the femoral head","volume":"42","author":"Kobayashi","year":"2018","journal-title":"Int Orthop"},{"key":"2024043021570443000_14.3.e082342.25","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.arth.2019.11.029","article-title":"The 2019 revised version of association research circulation osseous staging system of Osteonecrosis of the femoral head","volume":"35","author":"Yoon","year":"2020","journal-title":"J Arthroplasty"},{"key":"2024043021570443000_14.3.e082342.26","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.arth.2022.02.009","article-title":"The 2021 association research circulation osseous classification for early-stage Osteonecrosis of the femoral head to computed tomography-based study","volume":"37","author":"Koo","year":"2022","journal-title":"J Arthroplasty"},{"key":"2024043021570443000_14.3.e082342.27","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker277"},{"key":"2024043021570443000_14.3.e082342.28","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002787","article-title":"Prevalence and risk factors of Osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a Multicentre cohort study","volume":"9","author":"Mimura","year":"2023","journal-title":"RMD Open"},{"key":"2024043021570443000_14.3.e082342.29","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/14397595.2021.1899452","article-title":"Geographic distribution of the incidence of Osteonecrosis of the femoral head in Japan and its relation to smoking prevalence","volume":"32","author":"Tani","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2024043021570443000_14.3.e082342.30","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1007\/s00776-012-0293-x","article-title":"Pronounced risk of nontraumatic Osteonecrosis of the femoral head among cigarette Smokers who have never used oral corticosteroids: a multicenter case-control study in Japan","volume":"17","author":"Takahashi","year":"2012","journal-title":"J Orthop Sci"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-082342","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T05:27:58Z","timestamp":1714541278000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-082342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,29]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/bmjopen-2023-082342"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-082342","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}