Objective  To sort out and analyze the findings on biomechanics and evidence-based clinical study of the China-Japan Friendship Hospital (CJFH) classification of osteonecrosis of the femoral head (ONFH) in the past ten years.

Methods  Search for researches related to CJFH classification in CNKI, WanFang Data, VIP, SinoMed, MEDLINE, ScienceDirect, PebMed, Web of Science. Searching time was from July, 2012 to June, 2023. Literature was selected according to inclusion and exclusion criteria. The literature was analyzed from different perspectives, which could be categorized into four aspects: biomechanics, prediction of the collapse of the femoral head, assessment of different joint preserving protocols, and joint preserving choices.

Results  A total of 34 studies were included. Biomechanical studies explored and validated the CJFH classification from both macro and micro perspectives, providing ample theoretical support for the classification. Additionally, several studies used the CJFH classification to categorize their research subjects. As the classification level increased, both the clinical success rate and femoral head survival rate of patients significantly decreased, and this conclusion applied to most hip-preserving treatment methods. The CJFH classification accurately and reproducibly predicted the progression collapse rate and treatment prognosis of femoral head necrosis, providing evidence support for the clinical application of this classification.

Conclusion  CJFH classification can predict the collapse of the femoral head, assess joint preserving treatments, and guide clinical decisions. It can be combined with new technology in the aspect of layer selection to ensure clinical applicability and improve accuracy.

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