[Interpretation of the 2026 Association Research Circulation Osseous (ARCO) International Evidence-Based Clinical Practice Guideline: Diagnosis and Treatment of Nontraumatic Osteonecrosis of the Femoral Head].

Nontraumatic osteonecrosis of the femoral head (ONFH) predominantly affects young and middle-aged adults and carries a high risk of disability. Substantial variations exist in diagnostic and treatment strategies worldwide, and unified evidence-based standards have been lacking. In April 2026, the Association Research Circulation Osseous (ARCO) published the first international multidisciplinary evidence-based clinical practice guideline for nontraumatic ONFH. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the guideline formulated 12 standardized recommendations for diagnosis and treatment. One of the authors participated throughout the guideline-development process as a member of the Chinese working group. This article interprets all 12 recommendations and compares international and Chinese diagnostic and treatment strategies in the context of existing Chinese guidelines and clinical practice. It also examines limitations in the available evidence and proposes approaches for implementing the recommendations in China, thereby providing an evidence-based reference for standardized staging, hip-preserving treatment, and individualized decision-making between joint preservation and arthroplasty for patients with nontraumatic ONFH.