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Developing International Clinical Practice Guidelines: Lessons Learned in Achieving Global Consensus for the
Edward Y Cheng1, Michael A Mont2, Stuart B Goodman3
1Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.
The Journal of Arthroplasty
|June 18, 2026
Summary
Developing international clinical practice guidelines (CPGs) for nontraumatic osteonecrosis of the femoral head (ONFH) requires careful planning. Key lessons learned emphasize a life-cycle approach for global adoption and improved patient care.
Area of Science:
- Orthopedics and Bone Health
- Evidence-Based Medicine
- Clinical Guideline Development
Background:
- International clinical practice guidelines (CPGs) aim to standardize evidence-based care globally.
- Nontraumatic osteonecrosis of the femoral head (ONFH) presents unique challenges due to heterogeneous biology and limited high-certainty evidence.
- Developing international CPGs involves significant logistical, methodological, and implementation hurdles.
Purpose of the Study:
- To summarize key lessons learned from developing the first international, evidence-based CPG for ONFH by the Association Research Circulation Osseous (ARCO).
- To identify best practices for international guideline development, particularly for complex orthopedic conditions.
Main Methods:
- Analysis of lessons learned across multiple domains during the ARCO-led international ONFH CPG development.
- Focus on panel structure, virtual collaboration, methodological expertise, literature review, and recommendation formulation.
- Consideration of global variability in resources, language, and clinical context.
Main Results:
- Successful development of the first international, evidence-based CPG for ONFH.
- Identified critical lessons in panel management, virtual collaboration, and evidence synthesis.
- Highlighted the importance of resource-stratified recommendations, translation, cultural adaptation, and patient values.
Conclusions:
- International guideline development requires a proactive approach to address logistical and methodological challenges.
- A life-cycle approach, extending beyond publication, is crucial for equitable adoption and impact.
- Incorporating global context and patient preferences enhances the real-world applicability of CPGs for ONFH and similar conditions.
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